- Premera Blue Cross (Mountlake Terrace, WA)
- …. In partnership with Premera Medical Directors and Provider Network Executives, the ** Quality and Risk Adjustment - Provider Clinical Consultant ... for documentation and coding best practices for HEDIS and risk adjustment . This role will have a...and Informatics and other key Premera stakeholders to support provider capability to provide quality … more
- Molina Healthcare (NE)
- …and comfortable working in a fast-paced environment + -Knowledge of Risk Adjustment , Quality , and Provider Engagement Strategies + -Experience with ... + Works with operational leaders within the business to provide recommendations on opportunities for process improvements. + Creates...Healthcare data (Member, Provider , Claims, etc.) + -Vendor Management + -Experience with… more
- Elevance Health (Atlanta, GA)
- **Business Change Director- Risk Adjustment Data Quality ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates must ... live within 50 miles of a PulsePoint location. The **Business Change Director for Risk Adjustment Data Quality ** will serve as a strategic partner for the… more
- Highmark Health (Harrisburg, PA)
- …Role requires the incumbent to: + **Lead and manage a team of interoperability and risk adjustment SMEs:** Provide guidance, mentorship, and support to team ... management, providing insights and actionable strategies to optimize data quality and risk adjustment . The incumbent works closely with senior/executive… more
- CenterWell (Tallahassee, FL)
- …of our caring community and help us put health first** The Associate Director, Risk Adjustment oversees quality assurance audits of medical records, ... other payers, and over government agencies. In addition, the Associate Director, Risk Adjustment oversees all medical coding education activities. The Associate… more
- Centene Corporation (Jefferson City, MO)
- …federal, and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and ... to improve provider performance in areas of Quality , Risk Adjustment and Operations...encounters). + Identifies specific practice needs where Centene can provide support. + Develops, enhances and maintains provider… more
- Molina Healthcare (Las Vegas, NV)
- …The Specialist, Provider Quality contributes to one or more of these quality improvement/ risk adjustment functions: + Implements key quality and ... to the Provider Network; ensures maintenance of Provider Quality Improvement programs in accordance with...manages, and/or compiles the required documentation to maintain critical quality improvement, risk adjustment and… more
- CareFirst (Baltimore, MD)
- …actionable reports to solve problems, provide data-driven guidance, and monitor risk adjustment performance. Provide analytical support on various ... developing materials and presenting key updates to leadership regarding risk adjustment programs and provider ...results of analyses to improve awareness and understanding of risk adjustment results and quality ,… more
- Somatus (Mclean, VA)
- … Network Management and the Quality Program to implement tactics for risk adjustment optimization, particularly for provider and member engagement ... well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation… more
- The Cigna Group (Bloomfield, CT)
- **Job Summary:** The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, ... and suggests improvements in data and processes for Continuous Quality Improvement (CQI). **Key Job Functions:** * Conduct medical...and any additional applicable rule set. * Utilize HHS' Risk Adjustment Model to confirm accuracy of… more