- Humana (Santa Fe, NM)
- …to drive efficient, effective, and compliant risk adjustment processes. This Risk Adjustment Risk Management lead position will be responsible ... Management Lead acts as a consultant to the Risk Adjustment team leaders, as programs and...Management and is responsible for oversight of the Risk Adjustment Operations processes. The Risk… more
- Molina Healthcare (Albuquerque, NM)
- …of Quality Discipline including metrics and performance standards. Working knowledge of Risk Adjustment . Project management experience, in a managed ... **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading health plan execution for Risk Adjustment and Quality… more
- Baylor Scott & White Health (Santa Fe, NM)
- …and external sources to provide insight to decision-makers. This role supports program management activities around risk adjustment data management ... procedure documentation. + Oversee updates to department policies and procedures regarding risk adjustment data management . + Remain current on CMS Risk… more
- Datavant (Santa Fe, NM)
- …and roadmap for the Data Integration pod within the Retrospective Risk Adjustment Coding Product Suite + **Client Data Management :** Oversee secure and ... to realize our bold vision for healthcare. **Role Overview** As a Product Manager, Risk Adjustment Coding Data Integration, you will own the data strategy and… more
- Datavant (Santa Fe, NM)
- …and life experiences to realize our bold vision for healthcare. As an Auditor, HCC Risk Adjustment Coder, you will review medical records to identify and code ... using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical… more
- Datavant (Santa Fe, NM)
- …vision for healthcare. We're looking for experienced and credentialed Auditing Team Lead, HCC Risk Adjustment Coding to become an integral part of our team. The ... for education opportunities in both quality and productivity to management for review and/or action. + Assists in auditing...95% or higher. + Any other tasks required by management . What you will bring to the table: +… more
- Datavant (Santa Fe, NM)
- …for healthcare. Auditing Supervisor serves as a working supervisor with oversight and management of Risk Adjustment team members. This includes monitoring ... findings on a daily basis, including education on time management and best coding practices. + Provide coaching and...the role. + Report trends for education opportunities to management for review and/or action. + Motivate team members… more
- Datavant (Santa Fe, NM)
- …using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical ... skills, problem solve, ability to work in a remote environment, and time management skills. + Working knowledge of the business use of computer hardware and… more
- Molina Healthcare (Albuquerque, NM)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment , disease ... regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management … more
- Molina Healthcare (Santa Fe, NM)
- …HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment , disease ... Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and… more
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