• Manager, Provider Engagement (Remote in WI)

    Molina Healthcare (Madison, WI)
    …The Manager, Provider Engagement establishes strategies and operational directions for risk adjustment and quality improvement. Collaborates with senior ... strategies. Sets and manages performance goals, ensuring providers meet quality and risk adjustment targets through coaching and consistent engagement. Tracks… more
    Molina Healthcare (06/22/25)
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  • Vice President HEDIS Strategy

    AmeriHealth Caritas (Newtown Square, PA)
    adjustment models (CMS, HHS,STARS, HEDIS, and value based care. + Risk adjustment program oversight with leading design, implementation, and monitoring. ... as the leader responsible for driving the Quality Performance Reporting & Analytics and Risk Adjustment for Medicaid Quality, Medicare Stars, and Exchange… more
    AmeriHealth Caritas (07/30/25)
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  • Sr. Specialist, Provider Engagement - HEDIS…

    Molina Healthcare (Syracuse, NY)
    …Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures ... providers in the Health Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve… more
    Molina Healthcare (06/07/25)
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  • Inpatient Registered Nurse or Social Worker (MSW)…

    St. Luke's University Health Network (Easton, 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
    St. Luke's University Health Network (07/04/25)
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  • Revenue Management Educator (Remote Option within…

    Marshfield Clinic (Marshfield, WI)
    …stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy ... and integrity of risk adjustment data submitted to the Centers for ...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
    Marshfield Clinic (06/29/25)
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  • HIM Audit and Education Specialist

    Hartford HealthCare (Farmington, CT)
    …audit and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. ... documentation to disseminate audit requirements. 6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the… more
    Hartford HealthCare (07/24/25)
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  • Analyst, Informatics

    CVS Health (Blue Bell, PA)
    …every day. **Position Summary** Informatics Analyst candidate will be part of the is on the Medicare Risk Adjustment team and will play a crucial rile in ... for the process surrounding submission of Risk Adjustment data to the Center for Medicare ...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
    CVS Health (08/02/25)
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  • Director, Actuary

    WelbeHealth (Los Angeles, CA)
    …Python, R), Excel, and financial modeling tools + Deep understanding of CMS risk adjustment , Medicaid rate-setting, and Medicare Advantage/Part D payment ... and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported… more
    WelbeHealth (07/19/25)
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  • Intensive Case Manager (NY Helps), New York City…

    New York State Civil Service (Bronx, NY)
    …NY Zip Code 10461 Duties Description NYCCC is recruiting a Director of Clinical Risk Management Department to oversee their Risk Management Department and will ... with senior administrators as needed.* Acting as a resource to team leaders/ program directors as well as CRMs, identifying reportable incidents and facilitating the… more
    New York State Civil Service (08/01/25)
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  • Registered Nurse 3 Infection Control, (NY Helps),…

    New York State Civil Service (Brooklyn, NY)
    …treatment teams to mitigate potential for infectious disease.* Developing infection control risk assessment and plan along with educational programs for staff and ... patients.* Evaluating the effectiveness of the infection control program and revising as needed.* Leading annual flu prevention, treatment, and reporting.*… more
    New York State Civil Service (07/15/25)
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