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Risk Adjustment, Program Manager

Company: Optum
Location: Everett
Posted on: January 12, 2022

Job Description:

Job DescriptionJOB SUMMARY: Responsible for supporting the programmatic functions of the Pacific Northwest's risk adjustment, accurate coding and diagnosis, Quality and Affordability programs (RAQ) for risk based contracts (including Medicare Advantage and Dual Eligible, Accountable Care Organizations (ACOs), commercial or Medicaid capitation, and any other value-based performance reimbursement with chronic conditions) in new and developing markets in the Pacific Northwest region. Under the direction of the Director of Risk Adjustment & Quality Integration, the program manager supports the assessment, gap analysis, operational planning, deployment and management of RAQ programs for prospective and/or developing markets. -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 assessments, gap analysis and integration plans for prospective affiliate partners and acquisitions as part of the diligence process
  • Implements risk adjustment, quality, and affordability initiatives in our growth markets, including health assessment initiatives, HCC risk adjustment data & documentation integrity, and supporting vendor programs
  • Implement & manage programs in partnership with market leadership & PNW Value team leadership in the areas of Risk Adjustment, Quality and Affordability
  • 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.
  • Supports the assessment, implementation, and management of attestation programs to promote complete and accurate coding & documentation activities at the point of care.
  • Implements & manages vendors for programs such as in-home assessments, embedded NP visits, digital health tablets, retrospective & clinical chart reviews.
  • 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 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.
  • Prepares timely and accurate monthly and annual reporting as required.
  • Provide supplemental expertise and bandwidth in existing regional markets, as needed.
  • Requires significant collaboration with internal stakeholders including, but not limited to, primary care section and specialty service lines, IT, business services and finance, contracting, compliance, as well as external entities and vendors will be required.Duties listed below are integrated into all job functions:
    • 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 be facile at operating independently in new and ambiguous market scenarios
    • 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.
    • 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 OptumCare policies.
    • Attends training to meet requirements of the job position and as needed or mandated by OptumCare 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 and/or quality 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/Dual Eligible, 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:
        • 2-5 years minimum program coordination experience.
        • 5+ years health care experience.
        • Fluency in Microsoft applications.
        • United Health Group requires all new hires and employees to report their Covid-19 vaccination status.
        • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliancePreferred:
          • 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.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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

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