- Datavant (Providence, RI)
- …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Dignity Health (Bakersfield, CA)
- …ad hoc analysis to demonstrate insights and trends related to patient engagement, Medicare risk adjustment , STARS/HEDIS, Medical management, and program ... including payer data sources, including but not limited to; Medicaid, Traditional Medicare , Medicare Advantage, value based programs, among others. 3. Engaging… more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …on core metrics, including: + Preventative and Chronic Disease Management. + Risk adjustment , cost, utilization, and value-based performance. + Access, including ... behavioral health. + Team-based care models. + Expansion of Medicare and other services for the aging population. +...the CEO, CFO, CIPO and COO on managed care strategy , risk -based initiatives, and budget alignment with… more
- Humana (Providence, RI)
- …analyze large data sets + Knowledge of healthcare compliance, mainly primary care and risk adjustment , pharmacy knowledge a plus + Certified Coder (CPC, CRC, ... to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …delivery of high-quality, trustable clinical data to support key initiatives around quality, risk adjustment , medicare stars, and interoperability. This is a ... + Collaborate with cross-functional teams, including clinical operations, performance measurement, and risk adjustment , to execute on data procurement & usage… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance *Interview, hire, and supervise… more
- Banner Health (Phoenix, AZ)
- …This role leads enterprise strategies to improve cost efficiency, quality outcomes, risk adjustment accuracy, and contract performance across lines of business ... clinical engagement, the Senior Medical Director will ensure Banner's network strategy consistently delivers measurable value for patients, providers, and the… 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 ... clinical oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and… more