• Director Risk Adjustment

    Highmark Health (Pittsburgh, PA)
    Quality and Coding for the Highmark Health Enterprise. Ensures that Highmark's Risk Adjustment programs comply with all applicable guidelines, regulations and ... + Production Coding: Manage a team of internal coder / clinicians that perform Risk Adjustment coding of medical records. Track production coding results and… more
    Highmark Health (08/08/25)
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  • Health Care Disputes - Compliance Risk

    Ankura (New York, NY)
    …operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The Senior Director will also ... of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients. +… more
    Ankura (09/09/25)
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  • Director , Risk Adjustment

    Corewell Health (Grand Rapids, MI)
    Job Summary The Director Risk Adjustment Prospective Operations & Risk Mitigation is the thought leader role responsible for ensuring the complete and ... quality and overall impact of the company's risk adjustment program, including reporting KPIs on...collaboration cross all relevant internal departments/positions that intersect with risk adjustment ( Quality , Provider Relations,… more
    Corewell Health (07/21/25)
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  • Director , Prospective + Concurrent…

    Datavant (Augusta, ME)
    …for healthcare. **Role Overview** As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution ... on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review).… more
    Datavant (08/08/25)
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  • Director , Clinical Data Acquisition (HEDIS…

    Molina Healthcare (St. Petersburg, FL)
    …monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment , Risk Adjustment Data Validation, and ... **Job Description** **Job Summary** The Director , Clinical Data Acquisition is responsible for the...that support business objectives. + HEDIS Operations experience. + Risk Adjustment and Data Validation experience. +… more
    Molina Healthcare (08/21/25)
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  • Director of Client Success, Payer…

    Datavant (Olympia, WA)
    …strategic mindset and a focus on continuous improvement. + Familiarity with CMS HCC risk adjustment processes preferred \#LI-BC1 We are committed to building a ... experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP...updates, etc.). + Identify project risks that impact the quality of our product and services delivery to clients,… more
    Datavant (07/18/25)
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  • Director , Registered Nurse/Certified…

    Ankura (New York, NY)
    …college/university + Current Registered Nurse license + Experience working for payors conducting risk adjustment reviews + Clinical experience in a variety of ... and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside… more
    Ankura (09/09/25)
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  • Risk Adjustment Analyst, Health…

    University of Utah Health (Murray, UT)
    …utilization, cost structure, and/or quality . + Demonstrated knowledge with the specific risk adjustment models. HHS HCC, CMS HCC and MARA. + Demonstrated ... to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission....trust that are integral to our mission. EO/AA_ + Risk Adjustment Analyst position provides support for… more
    University of Utah Health (08/13/25)
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  • Manager, Risk Adjustment Coding…

    Evolent (Helena, MT)
    …You'll Be Doing:** **Manager, Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment Coding Support Manager to be a core member of the ... Risk Adjustment Coding Support team. Evolent Care...progress note clinical documentation review. + Ensure compliance and quality for all coding practices maintaining high standards and… more
    Evolent (08/29/25)
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  • Database Developer (Healthcare / Risk

    Commonwealth Care Alliance (Boston, MA)
    Director of Encounter Data Management within the Revenue Cycle Department, the Risk Adjustment Data Developer is responsible for the design, development, and ... of data systems and tools that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category (HCC) revenue programs. This… more
    Commonwealth Care Alliance (06/25/25)
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