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Risk Adjustment, Program Manager

Company: Optum
Location: Tacoma
Posted on: November 22, 2020

Job Description:

Job Title: --Program Manager, Risk AdjustmentSupv Approval/Date:Department:-- Risk AdjustmentHR Approval/Date:Job Code:--FLSA Status:---- ExemptRange:--EEO Code:--Reports To:---- Director, Risk AdjustmentTier:-- JOB SUMMARY: Responsible for supporting the programmatic functions of the Washington region's risk adjustment program, including health assessment initiatives, HCC risk adjustment data & documentation integrity, and supporting vendor programs. Under the direction of the Senior Director of Risk Adjustment, deploys and maintains regional programs to ensure a Washington maintains a high performing risk adjustment program.ESSENTIAL DUTIES & RESPONSIBILITIES: The duties listed below are intended only as illustrations of the various types of work that may be performed.-- The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment.

  • Supports patient engagement and outreach programs to facilitate comprehensive health assessment for Medicare Advantage patient population, and other managed or risk-based populations. This includes ensuring high risk patients are being seen and that all patients are seen in a timely manner.
  • Implements and manages vendors for programs such as in health assessments and embedded NP visits.
  • Supports implementation of programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart.-- Programs include, but are not limited to training and educational activities and coordination of random targeted documentation audits and concurrent follow up feedback.
  • Supports coordination of clinician chart audit activities and operational aspects of clinical chart reviews, including identifying and data mining patient lists, coordinating chart provisions with reviewers, communicating results to education teams.
  • Organize and provide executive, management and front-line initiatives and performance reporting and communication for any manages programs.
  • Supports implementation of market toolsets maintenance of existing tool sets, such as point of care tools.
  • Supports implementation of programs designed to ensure all diagnosed codes and conditions are properly supported and submitted to Health Plan partners.-- Programs include submission, reconciliation, and electronic data submission.
  • All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patients.
  • Must relate to other people beyond giving and receiving instructions: (a) get along with co-workers or peers without exhibiting behavioral extreme; (b) perform work activities requiring negotiating, instructing, supervising, persuading or speaking with others; and (c) respond openly and appropriately to feedback regarding performance from a supervisor.
  • Performs all duties in a manner which promotes and supports the Core Values and Compact of The Everett Clinic.
  • Integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction.
  • Frequently must follow written and oral instructions as well as complete routine tasks independently.
  • Completes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs Agreements.
  • Ensures confidentiality of patient information following HIPAA guidelines and TEC policies.
  • Attends training to meet requirements of the job position and as needed or mandated by TEC policies, Div. of Occupational Safety & Health (DOSH), OSHA, L&I and other state/federal regulations.
  • Has regular and predictable attendance.PREFERRED QUALIFICATIONS:Knowledge, Skills & Abilities: Note that these requirements are representative, but not all-inclusive, of the knowledge, skill, and ability required to perform this job.
  • Experience supporting risk adjustment activities in a large HMO or provider organization
  • Ability to interact effectively with C-Level employees across the organization
  • Knowledge of regulations related to Medicare Advantage, Medicaid, Commercial risk adjustment
  • Knowledge of claim coding and payment methodology utilized in Medicare and Medicaid lines of business
  • Ability to initiate and maintain cross-team relationships
  • Excellent analytical and problem-solving skills
  • Ability to effectively direct preparation of various financial analysis and data mining activities
  • Ability to effectively interface with staff, clinicians and management
  • Excellent teaming/interpersonal and verbal and written communication skillsEducation: Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.----------Experience: Minimum:
  • 3-5 years minimum program coordination experience.
  • 5+ years health care experience.
  • Fluency in Microsoft applications.Preferred:
    • 1-3 years minimum management experience.
    • Background in supporting population health management and/or risk adjustment activities and clinical informatics.
    • Experience in analytics and data analysis.------------------PHYSICAL AND MENTAL DEMANDS The physical and mental demands described here are representative of those that must be met by employees to successfully perform the essential functions of this job.--PHYSICAL DEMANDS: While performing the duties of this job, employees are regularly required to sit, walk and stand; talk or hear, both in person and by telephone; use hands repetitively to finger, handle, feel or operate standard office equipment; reach with hands and arms; and lift up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus.MENTAL DEMANDS:While performing the duties of this job, employees are regularly required to use written and oral communication skills; read and interpret data, information and documents; analyze and solve non-routine and complex office administrative problems; may use math and mathematical reasoning; observe and interpret situations; learn and apply new information or skills; perform highly detailed work on multiple, concurrent tasks; work under intensive deadlines with frequent interruptions; and interact with managers, staff, customers, patients, the public and others encountered in the course of work, some of whom may be dissatisfied or abusive individuals.TYPICAL WORKING CONDITIONS:-- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.Typical office conditions and noise level is usually quiet.-- Interaction with others is busy, constant and occasionally interruptive.-- Work may be demanding at times.-- May require ability to work irregular hours.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.CONTACT:-- Physicians, employees, patients, public and vendors.Job descriptions represent a general outline of job duties, functions and qualifications.-- They are not intended to be comprehensive in nature.-- In addition, jobs evolve over time and therefore their description may not reflect the precise nature of the position at a given point in time.

Keywords: Optum, Tacoma , Risk Adjustment, Program Manager, Executive , Tacoma, Washington

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