- Optum NV (Las Vegas, NV)
- …They will support the market oversight and direction of Outpatient Care Management Services, Medicare Risk Adjustment Factor (RAF) education as well as ... Medicare Advantage programs (STARS, RAF, HEDIS, CHAPS/HOS etc.) Experience with Medicare risk adjustment and presenting findings to client/providers… more
- UnitedHealth Group (Brooklyn, NY)
- …providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the ... programs focused on improving the quality of care for Medicare Advantage Members. Will be out in the field...diagnosis coding Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the… more
- Molina Healthcare (Long Beach, CA)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment , disease management, and ... utilization and effective resource management. Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director ... of Medicare Risk Adjustment and Analytics....of Medicare Risk Adjustment and Analytics. This role will...program results, and represent and advocate for the Risk Adjustment Team's business interests in corporate… more
- Elevance Health (Mendota Heights, MN)
- ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst...Performs data mining and data-driven analyses to evaluate historical program performance and to inform current operating decisions. +… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment coding ... and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical… more
- Blue KC (Kansas City, MO)
- …and technical teams to develop the tools, processes, and reporting required to ensure a compliant risk adjustment program . + Build and maintain the risk ... **Employee discount program ** **Job Description Summary:** The Director, Government Programs Risk Adjustment & Audit assumes overall leadership of the … more
- Trinity Health (Syracuse, NY)
- …to conduct Education if needed. Auditing Experience Posting **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding ... and documentation in alignment with risk adjustment models, conducting audits with analysis...value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well… more
- Highmark Health (Pittsburgh, PA)
- …Develop, oversee and adapt infrastructure (processes, systems, talent) to support an effective risk adjustment program as CMS/HHS/DPW evolves the models and ... for risk revenue management for all government program products (commercial ACA, Medicare , and Medicaid)....direct management experience Preferred: + 5 or more years' Medicare and/or Commercial risk adjustment … more
- Molina Healthcare (Roswell, NM)
- …Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items ... analytic / programming tools as needed + Reporting includes Risk Adjustment program performance metrics,...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
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