- Health Care Service Corporation (Mcallen, TX)
- …provider trainings on health plan coding initiative guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation. ... Experience in health insurance or health care setting + Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail… more
- Molina Healthcare (UT)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... in line with industry standards and best practices * Assists with new program implementation and supports the health plan in-source BH services * Additional duties… more
- New York State Civil Service (NY)
- …and treatment, your duties may include: * Clinical leadership. * Program Management. * Psychological services requiring expertise in neuropsychology, child and ... treatment and expert testimony. * Specialized assessment (functional, personality, risk , competency, vocational, education) * Design and application of behavioral… more
- Humana (Newark, NJ)
- …community and help us put health first** The Medical Records Retrieval Specialist ( Risk Adjustment Representative 2) travels to provider offices within New ... reviewed by Humana's Coding staff. Medical Records Retrieval Specialist ( Risk Adjustment Representative 2) + Travels up...+ This role is part of Humana's Driver safety program and therefore requires an individual to have a… more
- Humana (Montgomery, AL)
- …processes, reporting, and visualizations for all Humana Healthy Horizons Medicaid Risk Adjustment , prospective programs, and interoperability. Takes initiative ... Managed Care + Experience in Medicaid + Experience in risk adjustment + Experience with data mining...+ Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development… more
- CenterWell (Columbia, SC)
- …(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 model and drive… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... performance improvement and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and modeling and… more
- Centene Corporation (Springfield, IL)
- …and Information Set (HEDIS) performance + Responsible for quality improvement aspects of risk adjustment processes for all products + Collaborate with ... STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS) + Oversee provider...additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that… more
- Intermountain Health (Las Vegas, NV)
- …+ Collaborate with clinical, operational, and data teams to monitor KPIs, risk adjustment , utilization, and quality metrics across all value-based programs. ... cross-functional collaboration. This candidate will be responsible for overseeing all at- risk contracts, including Medicare Advantage, Medicaid Managed Care,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …health plan in response to regulatory changes. + Assists in the preparation of risk adjustment analyses. + Supports risk sharing analyses, capitation ... Job Description: Summer: The Summer College Internship Program is a 10-week, paid internship experience that...Accountabilities: + Assists in the development of rate or Medicare bid filings through analysis of benefit designs, claims… more