- Molina Healthcare (Green Bay, WI)
- …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
- CVS Health (Madison, WI)
- …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 (Janesville, WI)
- …plan products to coordinate a medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills ... + Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . + Conduct...of nursing. + Graduate of an accredited Nurse Practitioner Program + Physician Assistant Positions: + Bachelor's degree in… more
- Molina Healthcare (Madison, WI)
- …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