• Risk Adjustment Analyst

    CareOregon (Portland, OR)
    … Analyst Department Finance Exemption Status Exempt Requisition # 24959 Direct Reports N/A Manager Title Risk Adjustment Analytics Manager Pay & ... reside in Oregon or SW Washington Job Summary The Risk Adjustment Analyst performs data extraction, conducts... initiatives and strategies for both the Medicare and Medicaid lines of business. This position provides recommendations regarding… more
    CareOregon (05/03/25)
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  • Informatics Manager , Risk

    CVS Health (Topeka, KS)
    …has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will support data analysis, ... predictive modeling, and evaluation reporting within our Medicaid lines of business. The position will involve extracting,...Knowledge of health insurance concepts - Experience working in risk adjustment - Experience working at a… more
    CVS Health (05/16/25)
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  • Director of Actuarial and Risk

    Marshfield Clinic (Marshfield, WI)
    …exciting missions in the world!** **Job Title:** Director of Actuarial and Risk Adjustment Services **Cost Center:** 682891378 SHP-Actuarial **Scheduled Weekly ... **Job Description:** **JOB SUMMARY** The Director of Actuarial & Risk Adjustment Services is a key leader...participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must… more
    Marshfield Clinic (03/31/25)
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  • Risk Adjustment Healthcare Business…

    Elevance Health (Tampa, FL)
    …effectively consult and guide internal stakeholders on effective use and interpretation of risk adjustment data and KPIs + Provides expertise to lower-level ... Medicaid is strongly preferred + Healthcare business knowledge related to Risk Adjustment Payment Methodology strongly preferred + Advanced skills in… more
    Elevance Health (05/09/25)
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  • Intensive Case Manager (NY Helps), New York…

    New York State Civil Service (Bronx, NY)
    NY HELP Yes Agency Mental Health, Office of Title Intensive Case Manager (NY HELPS), New York City Children's Center, Bronx Campus, P26040 Occupational Category ... Duties Description NYCCC is recruiting a Director of Clinical Risk Management Department to oversee their Risk ...- Statewide (NY HELPS) program as an Intensive Case Manager if they have:* Bachelor's degree in social work,… more
    New York State Civil Service (05/02/25)
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  • Senior Manager Actuarial Analytics *Remote

    Providence (Portland, OR)
    …Direct Commercial pricing, rate setting and rate filing, forecasting, budgeting, and estimating risk adjustment and risk transfer payment amounts. + ... **Description** **Senior Manager Actuarial Analytics \*Remote * Candidates residing in...Medicare Advantage Bid + Experience with Commercial, Medicare, and Medicaid revenue methodologies. + Demonstrated experience with managing professional… more
    Providence (05/06/25)
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  • Cell Therapy Market Access Manager

    Bristol Myers Squibb (Orlando, FL)
    …more: careers.bms.com/working-with-us . **Summary:** The Cellular Therapy Market Access Manager (CMAM) is responsible for executing access and reimbursement ... and reimbursement, inclusive of private Commercial coverage, Medicare, and Medicaid + Knowledge of health economics + Thorough knowledge...by your state of residence, and 3) a driving risk level deemed acceptable by the Company. \#LI-Field If… more
    Bristol Myers Squibb (05/17/25)
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  • Nurse Program Manager Health Equity…

    Tufts Medicine (Lowell, MA)
    …aligned with the Hospital Quality and Equity Incentive Program of the Massachusetts Medicaid 1115 Waiver. This work will spread across the Tufts Medicine Health ... Medical Officer for Quality, the Melrose Wakefield Hospital Senior Director Quality, Risk Management & Patient Safety and the Lowell General Hospital Vice President,… more
    Tufts Medicine (04/30/25)
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  • Revenue Management Educator (Remote Option within…

    Marshfield Clinic (Marshfield, WI)
    …internal and external 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... data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services… more
    Marshfield Clinic (03/31/25)
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  • HIM Audit and Education Specialist

    Hartford HealthCare (Farmington, CT)
    …and education specialist will support documentation practices that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. Reporting ... to Manager of Audit and Education *_Position Responsibilities:_* *Key Areas...6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to… more
    Hartford HealthCare (04/24/25)
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