- Molina Healthcare (WI)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… 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
- St. Luke's University Health Network (Quakertown, PA)
- …patient as healthy as possible in the outpatient setting, minimizing the risk of readmissions. + Issues applicable state/federal regulatory notices as applicable ... ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),...(MOON), Bundle Payment Care Initiative (BPCI) notification. + Monitors risk assessment using available tools and implements discharge interventions… more
- Humana (Atlanta, GA)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... interrelate across segments and/or enterprise-wide. **Regional VP of Health Services, Humana Medicare Advantage** As the Regional VP of Health Services, you will… more
- Trinity Health (Boise, ID)
- …Trinity practices and policies. Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Conducts ongoing ... and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS). Monitor's accuracy of centralized coder's charge… more
- Deloitte (Tempe, AZ)
- …Experience with Medicaid waivers (ie, 1115, 1915 b/c, 1332) + Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, ... the individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for various… more
- AdventHealth (Apopka, FL)
- …social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient Identifies ... the patient stay through the monitoring of each patient's readmission risk scores and coordinating readmission mitigation interventions. Consults Social Work for… more
- AdventHealth (Altamonte Springs, FL)
- …Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient + ... the patient stay through the monitoring of each patient's readmission risk scores and coordinating readmission mitigation interventions. + Consults Social Work… more
- Molina Healthcare (Columbus, OH)
- …of key managed care concepts and provider reimbursement principles such as risk adjustment , capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), ... performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job Qualifications** **Required… more
- AdventHealth (Winter Garden, FL)
- …Incorporates social determinants of health into transitions of care planning and applies risk mitigation interventions to meet the individual needs of each patient + ... the patient stay through the monitoring of each patient's readmission risk scores and coordinating readmission mitigation interventions. + Consults Social Work… more