• Medicare Risk Adjustment

    Elevance Health (Mason, OH)
    ** Risk Adjustment Process Expert I** **Location:** Louisville, KY **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering ... an accommodation is granted as required by law. The ** Risk Adjustment Process Expert** is responsible for...adjustment experience strongly preferred. + 3 years of Medicare /Medicaid experience is strongly preferred. + Strong oral, written… more
    Elevance Health (11/14/25)
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  • Manager, Risk Adjustment Operations…

    Point32Health (Canton, MA)
    …and business division goals. This position will report to the Director of Risk Adjustment Strategy , Operations and Quality Assurance. **Job Description** ... will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare , Medicaid, and Duals product… more
    Point32Health (10/24/25)
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  • Health Care Disputes - Compliance Risk

    Ankura (New York, NY)
    …master's degree from an accredited college/university + 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either ... compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment . The… more
    Ankura (09/09/25)
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  • Director, Quality and Risk

    Humana (Springfield, IL)
    …of Network Performance, is responsible for the successful execution of Stars and Risk Adjustment strategy and performance within a designated region. ... performance. Provides input into functions strategy . The Director, Quality and Risk Adjustment will be responsible for developing relationships with key… more
    Humana (11/15/25)
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  • Director Risk Adjustment and Quality…

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …trends to support bid development and financial forecasting. * Tracks and evaluates risk adjustment initiatives performance across Medicare , ACA, and ... Cross and Blue Shield of Minnesota Position Title: Director Risk Adjustment and Quality Analytics - Actuarial...risk , care, and health. Your Responsibilities * Performs risk score computation and forecasting for Medicare ,… more
    Blue Cross and Blue Shield of Minnesota (11/01/25)
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  • Risk Adjustment Manager- Encounters…

    CareFirst (Baltimore, MD)
    … Manager plays a critical role in the development and execution of the corporate risk adjustment strategy . The role serves as a dedicated resource within ... the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading... strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations… more
    CareFirst (09/12/25)
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  • Risk Adjustment Supervisor - Coding…

    CareFirst (Baltimore, MD)
    …risks or barriers to leadership to ensure that all risk adjustment activities fully comply with Medicare , Medicaid, ACA, and state-specific regulations. ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Operations Supervisor supports...Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA… more
    CareFirst (09/13/25)
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  • AVP, Quality & Risk Adjustment - RN…

    Molina Healthcare (Ridgeland, MS)
    …ensuring alignment of strategy and activities with Enterprise, acting as the Risk Adjustment and Quality subject matter expert for the health plan. The ... **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading...design, implementation, and monitoring the effectiveness of a comprehensive Risk and Quality intervention strategy , acting as… more
    Molina Healthcare (09/25/25)
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  • Prin Div Strategy Consultant

    Health Care Service Corporation (Chicago, IL)
    …key performance indicators, trends, and financial acumen + Knowledge of Medicare Stars, Medicare Risk Adjustment , and Medicare Finance. + Strong ... leading the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider… more
    Health Care Service Corporation (10/08/25)
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  • Sr. Product Manager

    Convey Health Solutions (Fort Lauderdale, FL)
    …+ Lead Product Strategy : Define and execute the roadmap for the Medicare Advantage Risk Adjustment solution, ensuring alignment with company goals ... a highly skilled and results-driven Senior Product Manager to lead our Medicare Advantage Risk Adjustment solution portfolio. In this critical role, you will… more
    Convey Health Solutions (11/10/25)
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