- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Director of Risk Adjustment Location: Hybrid | Eagan, Minnesota Career Area: Special ... Services/Product Lines The Impact You Will Have The Director of Risk Adjustment is...to offer, please review our benefits page. Role Designation Hybrid Anchored in Connection Our hybrid approach… more
- Ankura (New York, NY)
- …operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and ... role is a key strategic leader who initiates, develops and executes/implements the multi-product risk adjustment strategy set by the executive leaders of Risk… more
- Centene Corporation (Austin, TX)
- …and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of ... assessments oversight and the monitoring work plans pertaining to Risk Adjustment . Partners with business areas to...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- Ankura (New York, NY)
- …college/university + Current Registered Nurse license + Experience working for payors conducting risk adjustment reviews + Clinical experience in a variety of ... and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside… more
- Elevance Health (Cincinnati, OH)
- …Capabilities and Experiences:** + Deep understanding of CMS-HCC and/or HHS-HCC risk adjustment methodologies strongly preferred. + Experience partnering with ... **Clinical Compliance Medical Director ** _Please note that per our policy t_...regulatory, compliance, and legal matters strongly preferred. + Certified Risk Adjustment Coder (CRC) or similar credential… more
- NASCO (Hartford, CT)
- …deployment of AI/ML (Machine Learning) and agentic models for payer analytics, risk adjustment , fraud detection, and personalized member engagement + ... **Overview** Under general direction, the Director of Data and AI Architecture will drive...and AI Architecture will drive the evolution of our hybrid data strategy and AI architecture to enhance our… more
- Bristol Myers Squibb (Princeton, NJ)
- …great teams and leaders across the BMS network. Will provide together with the Associate Director Risk Management and Director Quality Risk Management ... Stakeholder Partnering and Engagement: Support together with the Associate Director Risk Management the partnership with teams...Ability to travel 10-20 % as needed. **GPS_2025 GQ_2025** \#LI- Hybrid If you come across a role that intrigues… more
- Bristol Myers Squibb (Trenton, NJ)
- …lives. Read more: careers.bms.com/working-with-us . **Position Summary** Reporting to the Director , Inspection Readiness, the Associate Director will help drive ... extensively with teams and leaders across the BMS network. The Associate Director will support BMS' GMP/GDP Inspection Readiness strategy by supporting on-site and… more
- Elevance Health (Waukesha, WI)
- …and claims integrity. This leader brings proven experience in payer and provider risk adjustment initiatives and possesses a deep understanding of end-to-end ... **Clinical Documentation and Claims Integrity Director ** **Location:** **Virtual:** This role enables associates to...services enablement company-and is well-versed in Medicare and Medicaid risk adjustment policies, RADV auditing, and the… more