Director of Medicare Risk Adjustment Analytics and Reporting
3 days ago
Anticipated End Date: 2024-11-29
Position Title: Director of Medicare Risk Adjustment Analytics and Reporting
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of our Elevance Health PulsePoint locations.
Job Description:
Director of Medicare Risk Adjustment Analytics and Reporting
The Director of Medicare Risk Adjustment Analytics and Reporting is responsible for planning, directing and controlling the resources and efforts of reporting and data analysis team to accomplish the company objectives through information management.
How You Will Make an Impact:
- Obtains resources (people, funding, material, support) to support business unit information needs and strategic initiatives.
- Provides leadership in motivating subordinates to accomplish reporting and data analysis goals and objectives.
- Develops a strong team through training and effective organizational development practices.
- Reports project status and progress to business unit senior management.
- Ensures accuracy and timeliness of output and deliverables for assigned functional areas.
- Implements the policies, practices, and procedures of the company and business units supported.
- Has fiscal responsibility for area budgets.
- Establishes relationships with business users both internal and external.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Oversees entire reporting/analysis/consulting unit or all aspects of a centralized function.
- Participates with other executives to establish strategic plans and objectives.
- Makes final decisions for IM function at the business unit level and ensures operations' effective achievement of objectives.
- Coordinates project management across department & divisional line.
- Ability to communicate with customers about technical issues in non-technical terms.
- Understands the business processes that the system supports.
Minimum Requirements:
Requires Bachelor's degree and 10+ years experience leading project teams, or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Knowledge of IM technologies, organizational structure, and customer information needs preferred.
- 10+ years of experience in risk adjustment and data analytics preferred.
- Experience with SAS, SQL, Python, R, or similar tools/languages strongly preferred.
- Prior leadership or management experience strongly preferred.
- Effective communication skills, including facilitation, consultation, negotiation and persuasion preferred.
- Experience with multiple risk adjustment models (MA, ACA, Medicaid) and markets preferred.
- Familiarity with Star and other quality incentive programs preferred.
Job Level: Director
Workshift:
Job Family: RDA > Reporting & Data Analysis
Who We Are:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work:
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
#J-18808-Ljbffr-
Los Angeles, California, United States Hueman Risk Adjustment Full timeJob OpportunityHueman Risk Adjustment is seeking a skilled Nurse Practitioner to join our team in completing in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Bell, CA.This unique opportunity offers a flexible schedule, allowing you to achieve your professional goals on your terms. Whether you're seeking supplemental...
-
Los Angeles, California, United States Hueman Risk Adjustment Solutions Full timeHueman Risk Adjustment Solutions is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in California. This is a short-term contract role in which the NP will be contracted to complete at least a 4-week assignment. The NP will be expected to work 5 days a week during their assignment.This...
-
Certified Nurse Practitioner
4 weeks ago
Los Angeles, California, United States Advantmed Full timeAbout AdvantmedAdvantmed is a leading provider of risk adjustment, quality improvement, and value-based solutions to health plans and providers. We drive market-leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners.Our MissionWe focus on identifying, managing, and...
-
Nurse Practitioner Traveler
1 month ago
Los Angeles, California, United States Hueman Risk Adjustment Solutions Full timeJoin Our Team of Healthcare ProfessionalsHueman Risk Adjustment Solutions is actively seeking skilled Nurse Practitioners to join our team of healthcare professionals. As a key member of our team, you will be responsible for conducting in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in California.About the RoleThis is a short-term...
-
Medicare Claims Appeals Specialist
4 weeks ago
Los Angeles, California, United States Med National Staffing Inc. Full timeJob DescriptionWe are seeking a detail-oriented Medicare Claims Appeals Specialist with a comprehensive understanding of Medicare claims processing, including provider contracts, Division of Financial Risk (DOFR), explanation of benefits, and claim edits.Key Responsibilities:Review and process Medicare provider appeals cases for California clients, adhering...
-
Medicare Advantage EDI Operations Specialist
4 weeks ago
Los Angeles, California, United States University of California Full timeJob SummaryAs a key member of our Medicare Advantage Operations team at UCLA Health, you will play a vital role in maintaining and running processes for electronic claims and other EDI transactions.This involves working with external trading partners, transferring/loading data through secure channels, and testing files from new providers/trading partners.You...
-
Nurse Practitioner NP, Contract, Traveler, HRA
5 months ago
Los Angeles, United States Hueman Risk Adjustment Solutions Full timeDescription Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in California. This is a short-term traveler role in which the NP will be contracted to complete at least a 4-week travel assignment. The NP will be expected to work 5 days a week during their assignment. This unique...
-
Nurse Practitioner
2 weeks ago
Los Angeles, California, United States Advantmed Full timeRole SummaryWe are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. As a key member of our team, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at-risk populations.Key ResponsibilitiesPerform annual in-home wellness visits and...
-
Director of Clinical Data Analytics
5 days ago
Los Angeles, United States JWCH Institute Full timeJob DescriptionJob DescriptionPosition Purpose:The Director of Clinical Data Analytics will be responsible for leading and managing the Data Governance Department. In this capacity, the Director will oversee a team of data analysts and support staff to implement policies and procedures established by the Data Governance Committee. This role will interact...
-
Senior Director, Retail Analytics
2 months ago
Los Angeles, United States Harnham Full timeJob Title: Senior Director of Retail AnalyticsLocation: Los Angeles, CA (Hybrid - NOT remote eligible)Salary: $225-250k base + bonus + equityCompany Overview:A solutions-based apparel company that has experienced rapid growth and profitability since its founding in 2016. This direct-to-consumer e-commerce business is expanding into retail, with five stores...
-
Senior Director, Retail Analytics
2 weeks ago
los angeles, United States Harnham Full timeJob Title: Senior Director of Retail AnalyticsLocation: Los Angeles, CA (Hybrid - NOT remote eligible)Salary: $225-250k base + bonus + equityCompany Overview:A solutions-based apparel company that has experienced rapid growth and profitability since its founding in 2016. This direct-to-consumer e-commerce business is expanding into retail, with five stores...
-
Pricing Analytics Director
4 weeks ago
Los Angeles, California, United States KPMG Full timePricing Analytics Director RoleKPMG is seeking a skilled Pricing Analytics Director to join our Growth and Strategy organization. As a key member of our team, you will be responsible for conducting ad-hoc pricing studies and analyses to support long-term growth goals. Your expertise in evaluating opportunities for pricing improvement and competitive price...
-
Director, Label Analytics
4 weeks ago
Los Angeles, California, United States Sony Music Entertainment US Full timeAbout Sony Music EntertainmentSony Music Entertainment is a global leader in the music industry, with a rich history of innovation and creativity. As a key player in the industry, we're committed to artistic integrity, transparency, and entrepreneurship.As a Director, Label Analytics, you will be the primary commercial analytics lead for a label within Sony...
-
Risk Management
2 weeks ago
Los Angeles, United States JPMorgan Chase & Co. Full timeBring your expertise to JPMorgan Chase. As part of Risk Management and Compliance, you are at the center of keeping JPMorgan Chase strong and resilient. You help the firm grow its business in a responsible way by anticipating new and emerging risks, and using your expert judgement to solve real-world challenges that impact our company, customers and...
-
Director of Financial Aid Compliance
4 weeks ago
Los Angeles, California, United States Otis College of Art and Design Full timeWe are seeking a highly skilled Director, Financial Aid Compliance to oversee the accurate administration of financial aid programs at our institution. This role involves ensuring adherence to federal, state, and institutional financial aid regulations and policies.Key Responsibilities:Ensure Regulatory Compliance: Monitor and enforce adherence to federal,...
-
Bodily Injury Claims Adjuster
4 weeks ago
Los Angeles, California, United States Aspire General Insurance Full timeAspire General Insurance Company is committed to delivering exceptional service and affordable specialty auto coverage to drivers. Our company values are centered around ABLE, which stands for always doing the right thing, being yourself, learning and evolving, and executing.We are seeking a highly skilled Bodily Injury Claims Adjuster to join our team. The...
-
Director, Strategic Planning and Performance
3 weeks ago
Los Angeles, United States Blue Shield Of California Full timeYour Role The Director, Strategic, Planning and Performance will report to the VP, Medicare in supporting the direction, development and execution of the management process for our National Medicare line of business. The goal of this work is to ensure strategy, communications, regularly held multi-Health Plans forums and information sharing work together in...
-
Manager, Forecasting + Analytics
3 months ago
los angeles, United States Summer Fridays Full timeJOB TITLE: Manager, Forecasting + AnalyticsREPORTS TO: Director, Forecasting + AnalyticsDEPARTMENT: SalesOVERVIEWThe Forecasting & Analytics Manager plays a pivotal role in developing and maintaining channel and SKU level forecasts for select accounts with a key emphasis on forecast accuracy to maximize sales and optimize...
-
Manager, Forecasting + Analytics
2 months ago
Los Angeles, United States Summer Fridays Full timeJOB TITLE: Manager, Forecasting + AnalyticsREPORTS TO: Director, Forecasting + AnalyticsDEPARTMENT: SalesOVERVIEWThe Forecasting & Analytics Manager plays a pivotal role in developing and maintaining channel and SKU level forecasts for select accounts with a key emphasis on forecast accuracy to maximize sales and optimize in-stocks. The ideal candidate...
-
Manager, Forecasting + Analytics
3 months ago
los angeles, United States Summer Fridays Full timeJOB TITLE: Manager, Forecasting + AnalyticsREPORTS TO: Director, Forecasting + AnalyticsDEPARTMENT: SalesOVERVIEWThe Forecasting & Analytics Manager plays a pivotal role in developing and maintaining channel and SKU level forecasts for select accounts with a key emphasis on forecast accuracy to maximize sales and optimize...
