- Mount Sinai Health System (New York, NY)
- …for driving key population health goals including access, quality, utilization and accurate risk adjustment with a group of practices and (2) close partnership ... with the CDQI Director to drive accurate risk adjustment throughout the system. This Medical Director must be effective at influencing physicians, medical… more
- Molina Healthcare (Syracuse, NY)
- **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of ... the integrity of enterprise revenue, and enabling the organization's overall risk adjustment strategy. Knowledge/Skills/Abilities + Responsible for encounters… more
- Molina Healthcare (Rochester, NY)
- …experience with proven relationship management responsibilities * Proven experience in risk adjustment , quality, and provider engagement. * Demonstrated ability ... related field. **PREFERRED EXPERIENCE:** 10+ years managed care experience specifically within Risk Adjustment and/or Quality To all current Molina employees: If… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …requesting and retrieving medical records from providers to the plan for review and for Risk Adjustment Validation Audits (RADV). * Acts as a preceptor to new ... related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. * May be assigned additional over read… more
- Ankura (Lexington, NY)
- …assessment. + Apply innovative techniques to healthcare engagements including those related to Risk Adjustment . + Expand and build new products in a ... an Industry thought leader in healthcare topics like predictive analytic applications, risk adjustment , and value-based care. + Develop, supervise, and motivate… more
- Deloitte (Rochester, NY)
- …care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment + Support business development efforts for Federal and ... with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, DSH, UPL,… more
- Humana (Albany, NY)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... + Experience in Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining and predictive modeling techniques + Ability… more
- Deloitte (Rochester, NY)
- …other Health Plan Actuarial liabilities for Premium Deficiency Reserves, Medicare Risk Adjustment , MLR (Minimum Loss Ratio) Calculations, Provider Liabilities ... for Incurred But Not Paid (IBNP) claims and Loss Adjustment Expense (LAE) for products covering Medical, Pharmacy, and.../ Risk -Sharing, and other Contract Reserves / Policy Reserves. +… more
- Datavant (Albany, NY)
- …reports directly to the Director of Strategic Operations. As a trusted partner to the Risk Adjustment COO and broader leadership team, you'll play a key role in ... for delivering results **Bonus Points If:** + You have experience in risk adjustment coding applications and technology \#LI-BC1 We are committed to building a… more
- Catholic Health Services (Rockville Centre, NY)
- …and as part of a multidisciplinary team. + Knowledge of quality metrics, care gaps, and risk adjustment coding is a plus. + Bilingual - Spanish speaking a plus ... discharges. + Established patients discharged from hospitals to reduce readmission risk and prevent suboptimal outcomes. + Collaborate with hospital discharge… more