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An outstanding opportunity with our client organization – National Managed care company with revenues over $1B.

We are seeking a Director of Medicare Risk to oversee the programs within the Medicare team.  This is a 100% remote opportunity.

Primary duties may include, but are not limited to:

  • Oversees daily operations of the retrospective and prospective review teams and programs and ensures the appropriate strategy, tactics and data capture processes are in place.
  • Serves as the vendor liaison to ensure coordination of efforts, effective relationship management, cost-effectiveness, delivery of work product, quality of work, delivery of required training for internal associates and timely communication on all issues.
  • Engages with enterprise functional areas to optimize identification of members with HCC conditions, facilitates efficient and effective interventions to ensure accurate and complete coding, and ensures at-risk members are referred to or engaged in care management programs.
  • Audits the chart review outcomes provided by the risk adjustment vendor and audits provider coding trends to identify potential gaps.
  • Works with PE&C to facilitate gap closure and consults on efforts that may improve provider engagement.
  • Serves as a key member of the Medicare Risk Adjustment Management team in developing processes for multidisciplinary, matrixed teams to execute the strategic vision and achieve the goals and objectives of the organization related to revenue optimization.
  • In consultation with VP of the Revenue Maximization team and Health Care Analytics, develops state-specific strategies and communicates recommendations to plan presidents.
  • Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Experience
5 years’ experience with Medicare or Medicaid risk adjustment processes or vendor management required
Must have 8 or more years of leadership experience
Must be able to travel up to 20% of the time within the West region
 
 
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