The Senior Risk Adjustment Analyst ensures accurate data submission to regulatory entities like CMS and optimizes risk models for HCCs and HEDIS performance. The role involves collaborating with internal and external partners to improve processes, maintain documentation, and provide mentorship to junior analysts.
PacificSource
8 Remote Job Openings at PacificSource
The Senior Risk Adjustment Analyst ensures accurate data submission to regulatory entities like CMS and optimizes risk models for HCCs and HEDIS performance. They lead cross-functional projects, manage vendor partners, and provide mentorship to junior analysts to improve risk adjustment processes.
Responsible for maintaining the accuracy and integrity of provider data, including demographic, credentialing, and contract information. Collaborates with internal teams to resolve data issues and ensures compliance with regulatory and accreditation standards.
Utilization Management Clinician (Tuesday - Saturday)
PacificSource
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Full Time
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a day ago
PacificSource
Coordinate healthcare delivery by performing utilization management services and concurrent reviews to ensure cost-effective, quality care. Collaborate with multidisciplinary teams to manage member benefits, preauthorizations, and discharge planning.
Utilization Management Clinician (Tuesday - Saturday)
PacificSource
·
Full Time
·
a day ago
PacificSource
Coordinate healthcare delivery by performing utilization management services and concurrent reviews for members in various care facilities. Collaborate with multidisciplinary teams to ensure cost-effective outcomes and facilitate appropriate levels of care.
Responsible for preparing GAAP, statutory, and regulatory financial reporting for PacificSource and its subsidiaries. The role also manages the income tax provision and compliance cycle across multiple regulated insurance entities.
Oversees utilization management for inpatient, post-acute, and Dual-Eligible Special Needs Plan (DSNP) members to ensure cost-effective and quality care. Leads a clinical team, manages departmental budgets, and implements process improvements using Lean methodologies.
Manage and sustain positive relationships with large employer groups and brokers to design strategic benefit programs and lead the renewal process. Act as a subject matter expert on insurance products, compliance, and population health strategies to ensure client satisfaction and cost containment.
