- UCLA Health (Los Angeles, CA)
- …and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk -based audits, ... contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide...audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with stakeholders and leadership to… more
- CenterWell (Arlington, TX)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and...as a team + Ensure clinicians effectively co-manage high risk episodes of care and patients with partnered Care… more
- CenterWell (Columbia, SC)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... coaching initiatives are precise + Identify critical issues for high- risk patients during case reviews & other forums, and...care as a team + Ensure clinicians effectively co-manage high- risk episodes of care and patients with partnered Care… more
- CenterWell (Daytona Beach, FL)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and coaching initiatives are precise *Identify critical issues for high- risk patients during case reviews & other forums, and...care as a team *Ensure clinicians effectively co-manage high risk episodes of care and patients with partnered Care… more
- ChenMed (Miami, FL)
- …information. Calculates statistical and probability forecasts and models from data. + Runs CMS risk adjustment model to calculate member level risk scores. + ... to join our team. Responsible for proactively managing and retrospectively tracking the risk positions within ChenMed as well as supporting the strategic goals of… more
- SSM Health (MO)
- …scoring. + Collaborates with others regardingclinical documentation improvement (CDI) and risk adjustment (mortality) findings. + Maintains knowledge of Centers ... represents the current health status of network patients against ever-changing risk adjusted models. Responsible for achieving improved documentation results and … more
- CenterWell (Kansas City, KS)
- …(clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... coaching initiatives are precise. + Identify critical issues for high- risk patients during case reviews & other forums, and...as a team. + Ensure clinicians effectively co-manage high risk episodes of care and patients with partnered Care… more
- Fallon Health (Worcester, MA)
- …preparation of actuarial components of financial reports, regulatory submissions, and risk adjustment analyses + Collaborate with cross-functional teams ... support key business functions such as pricing, reserving, forecasting, and risk analysis. **Responsibilities** **Primary Job Responsibilities** + Assist in the… more
- SSM Health (IL)
- …support an accurateDRGassignment, SOI, and/or ROM.Assists in the mortality review and risk adjustment process utilizing third-party models. + Demonstrates an ... Related Group (DRG) assignments, case-mix index, severity of illness (SOI), and risk of mortality (ROM) profiling, and reimbursement. Facilitates the resolution of… more
- NCH (Naples, FL)
- …well as applicable organizational policies and procedures. * Experience in MS-DRG and APR-DRGs, risk adjustment , HACs and PSIs, O/E mortality, and LOS. * Working ... assure documentation is clinically appropriate, accurately reflects the severity of illness and risk of mortality for the patient and is reflective of current CMS or… more