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NeueHealth

Related companies:

🏢 Acentra Health
🏢 highmark
🏢 Central California Alliance for Health

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🔥 Remote Lead Actuarial Consultant - Risk Adjustment
Posted 2024-10-21

📍 FL, TX, MN

🔍 Healthcare

  • Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field.
  • 8+ years of actuarial experience with 5+ years working within healthcare.
  • 3+ years working with a CMS/HHS HCC risk adjustment modeling is required.
  • 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred.
  • 2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred.
  • Working knowledge of the CMMI Direct Contracting or ACO program.
  • Experience leading projects and ownership of deliverables.

  • Build, maintain, and own the CMS HCC risk scoring model.
  • Lead quarterly risk adjustment analysis and forecasting.
  • Document and present summary review memos for quarterly analysis.
  • Evaluate financial implications of provider participation in networks.
  • Lead provider risk contract evaluations and performance evaluations.
  • Collaborate with Operations Risk Adjustment team on forecasting models.
  • Perform ad-hoc data analysis using Excel, SAS, SQL.

SQLData AnalysisVBAData analysisCollaborationMicrosoft Excel

Posted 2024-10-21
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🔥 Case Manager, RN - Remote
Posted 2024-10-21

📍 California, United States

💸 65745 - 98617 USD per year

🔍 Healthcare

  • RN License for California required.
  • Bilingual English and Spanish is a plus.
  • Minimum two (2) years of experience in medical management clinical functions.
  • Working knowledge of MCG, InterQual, and NCQA standards.
  • Active and Unrestricted License as a Registered Nurse (RN) required.
  • Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred.

  • Assessment of medical, social, and behavioral needs of assigned population.
  • Care Plan development and prioritization to transition members to health and self-management.
  • Coordinate interdisciplinary team meetings.
  • Collaboration across providers for quality outcomes.
  • Facilitate care coordination and self-management planning.
  • Link members to community resources to address social determinants of health.
  • Adjudicate referrals and coordinate care across settings.

Communication SkillsAnalytical SkillsCollaborationProblem Solving

Posted 2024-10-21
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