• ACA/ Medicare Risk Adjustment…

    Baylor Scott & White Health (Atlanta, GA)
    …internal and external sources to provide insight to decision-makers. This role supports program management activities around risk adjustment data management ... + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible...such as revenue forecasting and ROI. + Contributes to program improvement by designing and implementing business process and… more
    Baylor Scott & White Health (10/03/25)
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  • Risk Adjustment Actuarial Analyst II…

    Elevance Health (Columbus, GA)
    …for completing projects and performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of ... to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… more
    Elevance Health (09/30/25)
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  • Medical Director ( Medicare )

    Molina Healthcare (Augusta, GA)
    …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
    Molina Healthcare (09/12/25)
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  • Coding Data Quality Auditor

    CVS Health (Atlanta, GA)
    …auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified ... ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of... and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and… more
    CVS Health (10/16/25)
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  • Actuarial Consultant with Medicaid Experience

    Deloitte (Atlanta, GA)
    …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider...individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or … more
    Deloitte (10/10/25)
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  • Medical Director, Behavioral Health (TX/WA)

    Molina Healthcare (Augusta, GA)
    …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... in line with industry standards and best practices * Assists with new program implementation and supports the health plan in-source BH services * Additional duties… more
    Molina Healthcare (10/17/25)
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  • Lead Director, National VBC Performance Planning…

    CVS Health (Atlanta, GA)
    …consulting, financial strategic analysis. + Understanding of value-based care, including risk adjustment methodologies (eg, HCC coding), quality measurement ... development of provider performance improvement initiatives + Establish a program management framework for VBC improvement initiatives-- monitoring the impact… more
    CVS Health (10/10/25)
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