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Health care regulatory knowledge focusing on Fraud, Waste, and Abuse; knowledge of Value-based care, Medicare Advantage Organizations, ACO REACH and MSSP programs is required. Juris Doctor and a member in good standing of a state bar association (or Registered In House Counsel with the CA Bar.
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As pioneers in value-based care and innovators in medicine, we are consistently ranked as a top Accountable Care Organization (ACO) nationally. Success in Value-Based Care: Our ACO is among the most successful in the country, consistently achieving high-quality ratings and shared savings bonuses.
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We are seeking a dynamic and skilled Actuarial Workflow Lead to spearhead our efforts in supporting ACO REACH & MSSP performance evaluation and forecasting, as well as leading value-based contracting (VBC) workflows.
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Its network of more than 3,000 physicians, serving more than 355,000 HMO, ACO and PPO patients, is dedicated to improving care and reducing costs through innovative care management and care coordination programs, use of health care technology, and population health management strategies.
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Healthcare Domain Knowledge: Conceptual understanding of how hospitals and systems work, how theyre paid by commercial carriers and the government, and how changing reimbursement is necessitating that hospitals and health systems be able to identify and manage risk; be able to decipher the healthcare-alphabet-soup that includes ACA, ACO, AMA, BMI, CMS, through to HIE and HIPAA, etc.
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10+ years of experience in healthcare data analysis (including EMR/EHR, claims, eligibility and publicly available data such as CMS LDS) Utilization of analytical tools including SQL, SAS, SPSS, and/or open-source including Python and R, or similar.
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Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s) Support the Government Programs & Provider Risk Actuarial Models teams development of actuarial models to be used for medical expense and trend analysis and forecasting, provider risk contract evaluation, and ACO REACH / MSSP performance evaluation.
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The Senior Actuarial Consultant will lead actuarial workflows in support of ACO REACH & MSSP performance evaluation and forecasting. 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred.
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Steward is among the nation’s largest and most successful accountable care organizations (ACO), with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through a closely integrated network of hospitals, multispecialty medical groups, urgent care centers, skilled nursing facilities and behavioral health centers.
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Our client, an ACO, located on the near west side of Chicago, is seeking to add to their team another Medicaid Care Coordinator on a temp-to-hire, full time basis. Our client, an ACO, located on the near west side of Chicago, is seeking to add to their team another Medicaid Care Coordinator on a temp-to-hire, full time basis.
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O New patient referral intake including obtaining registration information, scheduling appointments, communicating appointment information back to Referral Coordinators and ensuring patients arrive for their appointmentso Contact New Patients who do not show for their appointment, “New Patient Reactivations”o Case Management including, but not limited to ACO, Total Joint Health Program, and sponsored teams2.
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Title: Director - ACO Growth Department: Business Development About the role: The Director - ACO Growth is responsible for driving growth. Establish and manage strategic growth plans in collaboration with ACO team leaders, leverage data to prioritize prospects and outline initiatives and tactics to achieve growth goals.
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Masters or equivalent in epidemiology, public health, mathematics, health services research preferred (but not required) Deep familiarity with HEDIS & CMS care quality measures; experience implementing both HEDIS and CMS measures using SAS and/or SQL.
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8+ years of experience in healthcare growth leadership, preferably in ACO settings. Engage with prospective practices in a consultative manner to evaluate fit and secure commitment to participate in Astrana Healths ACO.
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Develop action plans for regions and PODs to enhance overall ACO performance. As a Senior Clinical Coder, you will collaborate with various stakeholders to meet performance targets and develop action plans to enhance overall performance in the ACO. Your primary responsibilities will include supporting the onboarding and training of providers, collaborating with internal teams on quality initiatives, and conducting training sessions on coding and documentation guidelines.
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