Lead the design and execution of the Medicare Advantage Transformation plan.
Direct cross-functional workstreams to implement key MA initiatives.
Monitor key performance indicators for the MA business line.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Enhance healthcare quality by overseeing performance improvement initiatives.
Ensure compliance with regulations and support data analysis.
Monitor quality metrics and drive projects to improve healthcare outcomes.
Jobgether is a platform that connects job seekers with potential employers, using AI to match candidates with roles. They focus on ensuring applications are reviewed fairly and efficiently.
Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
Partner with Sales on strategic opportunities involving quality measurement and Star Ratings solutions.
Lead product demonstrations showcasing HEDIS performance analytics, care gap identification, and quality improvement capabilities.
Articulate how Cotiviti's solutions address NCQA HEDIS certification requirements.
Cotiviti is a healthcare analytics company. They focus on improving healthcare outcomes and reducing costs through data-driven solutions, serving health plans and providers. Cotiviti values diversity and inclusivity, and they are an equal opportunity employer.
Maintain internal CMS HCC and RxHCC models for calculating member level risk scores.
Support the monthly close process, including the development of actuarial risk adjusted revenue accruals and analysis of results.
Build reports to track ROI on various risk adjustment initiatives.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Lead the business strategy and execution for HEDIS outcomes.
Establish and manage incentive structures and provider engagement models.
Develop and oversee cross-functional initiatives that translate measure logic into actionable programs.
Clover Health is dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. They have built an innovative technology platform designed to put actionable clinical insights into the hands of physicians at the point of care.
Design and/or enhance targeted and annual risk assessments.
Construct specific and effective auditing and monitoring workplans based on risks identified.
Analyze compliance outcomes and ensure detected issues are referred for remediation.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector. With hundreds of thousands of members onboarded, they foster a mission-driven and collaborative culture, dedicated to transforming the U.S. healthcare system.
Serve as primary relationship lead for assigned health plan partners
Own internal revenue and performance targets tied to your payer markets
Analyze operational and program data to identify risks and growth opportunities
Mae is a venture-backed digital health solution on a mission to improve the health and quality of life for mothers, babies, and those who love them. Mae has created a space where complete digital care meets culturally-competent on-the-ground support.
Serves as Project manager of the PV Risk Management System to oversee, evaluate, characterize, strategize, implement, assess and track vera’s PV Risk Management obligations, commitments and proposed minimization measures.
Provide recommendations and guidance through subject matter expertise on risk management and risk minimization strategy to an assigned therapeutic area to ensure that product risk management strategies are consistent worldwide.
Work closely with cross-functional teams (e.g. Clinical Development, Clinical Operations, Medical Affairs, Regulatory Affairs, and Biostats) to ensure alignment of Vera’s global position for the PV risk management processes.
Vera Therapeutics is a late clinical-stage biotechnology company focused on developing treatments for serious immunological diseases. They aim to advance treatments that target the source of immunologic diseases in order to change the standard of care for patients. Their values inspire employees every day.
Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
Own the claim and supplemental submission workflow for CMS EDS submissions.
Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors.
Clover Health is reinventing health insurance by combining data with human empathy to keep members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most. They are passionate and mission-driven individuals with diverse areas of expertise. From Clover’s inception, Diversity & Inclusion have always been key to their success.
Participate in provider case reviews to identify trends and deficits.
Coach providers and participate in client meetings to support expectations.
Contribute to workflow design, QA improvements, and risk management.
Amwell transforms healthcare with technology and people. They aim to provide convenient, affordable, and effective care, serving large healthcare organizations in the U.S. and worldwide.
Provide direct supervision, coaching, and performance oversight to clinical managers.
Serve as a primary operational liaison between clinical teams and health plan care management teams.
Oversee onboarding and training for care teams and clinical managers.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers. They cultivate a dynamic and inclusive team environment.
Design and execute roadmap to decouple ticket volume from headcount.
Act as a strategic partner to internal stakeholders to ensure support requirements are integrated into the broader company roadmap.
Cultivate radical accountability and hold everyone to a high standard.
Aledade is a public benefit corporation that empowers independent primary care practices. Founded in 2014, they are the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.
Review detailed claim reports from a variety of sources to predict current and future claim costs.
Research medical conditions and treatment options using available resources.
Document the medical review clearly, including an analysis of current clinical condition(s) and future annual claims projection.
Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With an entrepreneurial culture and a strong emphasis on analytics, they help employers better manage their risk.
Set the strategic direction for federal and state quality measurement initiatives.
Provide executive oversight across the full measurement lifecycle.
Serve as a senior strategic advisor to federal and state clients.
American Institutes for Research (AIR) is a nonpartisan, not-for-profit institution that conducts behavioral and social science research and delivers technical assistance. They solve urgent challenges in the U.S. and worldwide by generating evidence and applying data-driven solutions, with headquarters in Arlington, VA.
Provide executive leadership and strategic oversight for enterprise operations and quality initiatives.
Own enterprise-wide HEDIS strategy, execution, and performance outcomes.
Build and lead a centralized PMO delivering weekly performance metrics across all sites.
Vanna Health aims to improve overall health and wellbeing for individuals with serious mental illness by fostering a sense of belonging. They promote collaboration across healthcare providers through innovative payment models and technology and are committed to culturally competent care.
Work in a partially remote environment, collaborating with team members virtually each day.
Serve as a Subject Matter Expert (SME) on quality improvement measures, customer needs, and payer‑specific quality initiatives across commercial and government programs.
Conduct proactive patient outreach to identify and close quality gaps—educating patients, scheduling screenings, supporting treatment plan adherence, and improving outcomes.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Build a scalable operational model capable of supporting rapid volume growth and new care modalities.
Develop and maintain operational processes that support high-quality clinical documentation, regulatory compliance, and risk adjustment accuracy.
Drive continuous improvement across scheduling, provider management, consult flow, and care delivery quality.
Everlywell is a digital health company pioneering the next generation of biomarker intelligence, combining AI-powered technology with human insight to deliver personalized, actionable health answers. Over the past decade, Everlywell has reshaped how and where health happens, transforming care for 60 million people and powering hundreds of enterprise partners.