- CareOregon (Portland, OR)
- …+ Experience in Medicaid, quality assurance, utilization review, case management, and/or risk adjustment + Experience with CareOregon or other CCO operations ... sustainability and integration of CCO-funded programs, including Quality Pool payments, risk share funds, VBPs and/or other CCO-derived investments for clinical… more
- CVS Health (Tallahassee, FL)
- …treatment protocols for DSNP/MMP and other complex health populations to optimize risk adjustment , clinical quality, and care management. * Actively participate ... oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for… more
- Molina Healthcare (Hartford, CT)
- …Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment , Provider Resolution Team, Provider Appeal and ... position plans, organizes, staffs, and coordinates the operations of state Medicaid, Medicare and Marketplace Health Plan operations. * Works with staff and senior… more
- Hartford HealthCare (Farmington, CT)
- …* Knowledge of ICD 10 Diagnostic and CPT coding regulations and guidelines and risk adjustment coding * Extensive knowledge of state, federal and Medicare ... regulations related to coding * Knowledge of the revenue cycle for the purpose of identifying issues, proposing and communicating corrective action/recommendations * Knowledge of third-party and insurance company operating procedures, regulations and billing… more
- New York State Civil Service (New York, NY)
- …living including:* Conducting the substance abuse assessments to determine the risk for substance use and harmful behaviors* Identifying treatment services ... will be required.This position is eligible for a Downstate Adjustment of $4,000.#LI-DNIIn order to be eligible for appointment...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Humana (Jefferson City, MO)
- …Electronic Medical Records, and/or Electronic Notifications. + Familiarity with CMS Risk Adjustment and Quality Measure Reporting. + Experience in ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Saint Francis Health System (Tulsa, OK)
- …to Population Health's clinical teams including quality, care management, pharmacy, risk adjustment program, and post-acute care initiatives. Reviews quality ... to include but not limited to, Community Care of Oklahoma, Medicare ACO, Saint Francis's employer-sponsored health plan. Decision Making: Independent judgment… more
- Stanford Health Care (Palo Alto, CA)
- …Staff & Community Education, Case Management Education & Training, Risk Management Identification & Referral + Clinical Care Coordination/Facilitation: Plan ... Assistance/Referrals, Appeals Management, Entitlement Program Coordination, Patient Benefits Coordination: CCS/GHPP/ Medicare /Medi-Cal/SSI + Performance & Outcomes Management: Federal/State/Local Regulatory Agency… more
- Humana (Greenville, SC)
- …community and help us put health first** The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 travels to provider offices within the region ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Henry Ford Health System (Troy, MI)
- …processes within value-based reimbursement models and initiatives. Reporting to the Director, Risk Adjustment and Value-Based Payment, the Program Manager is ... to both departmental staff and multi-disciplinary teams. + Knowledge of Medicare , Medicaid, Blue Cross and other third-party payers billing and reimbursement… more