- Molina Healthcare (St. Petersburg, FL)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Centene Corporation (Tallahassee, FL)
- …remote from home anywhere in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on ... adjustment regulatory landscape preferred + Risk Adjustment regulatory audit experience preferred + Medicare ...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- CVS Health (Tallahassee, FL)
- …codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. + ... Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a...ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of… more
- Molina Healthcare (St. Petersburg, FL)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... and effective resource management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality… more
- CenterWell (Jacksonville, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... improvement and coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and modeling and driving… more
- AdventHealth (Altamonte Springs, FL)
- …out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program *For eligible positions* + Whole Person Well-being and Mental Health ... Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient +… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... performance improvement and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and modeling and… more
- Bristol Myers Squibb (Tallahassee, FL)
- …governing rules and laws. + Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geography. + Immunology experience (emphasis on ... by your state of residence; and 3) a driving risk level deemed acceptable by the Company. Why You...Wellbeing support such as the BMS Living Life Better program and employee assistance programs (EAP). Financial well-being resources… more
- AdventHealth (Tampa, FL)
- …Guidelines and approved coding policies and procedures. . Participates in the mortality/ risk adjustment reviews when assigned. . Assists with post-payment DRG ... your family:** .Paid Days Off from Day One .Student Loan Repayment Program .Career Development .Whole Person Wellbeing Resources .Mental Health Resources and Support… more