Responsible for administration and oversight of the medical and
clinical activities of employed and contracted providers as well as
various operations functions within assigned market(s) to ensure
appropriate practices related to risk adjustment activities, HEDIS
measures, and any appropriate gaps in care. The Medical Director
works collaboratively with all facets of the business and business
leadership including Risk Adjustment, Clinical Education team,
other Medical Directors and leaders, coding department, physicians,
site administrators and operations, to educate and improve accurate
coding and documentation skills, leading to a more complete patient
The Risk Adjustment Medical Director is responsible to lead
efforts to improve risk adjustment programs including accurate
documentation and coding and to be accountable for those
improvements and outcomes. The Director acts as a resource for
national and network leadership as well as physicians, specialists,
The Risk Adjustment Medical Director is further responsible for
keeping up to date on changes in the Medicare risk adjustment model
or other documentation requirements.
Coordinates 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.
Responsible for onboarding, ongoing, and targeted education of
all physicians on coding and documentation for Medicare risk
Accountable for the overall improvement and performance in risk
Coordinates with clinician leadership to ensure the clinical
aspects of risk adjustment programs and best practices are
communicated to group and IPA providers.
Oversees preparation and implementation of clinical correlation
Interfaces with operational leadership to assist in
identification of operational and clinical best practices in
maximizing patient visits, re-evaluation rates and accurate and
proper coding; coordinates the dissemination of best practices to
sites, clinicians and IPAs providers / support staff.
Serve as a resource for the market, network, and national
operations on proper coding and documentation.
Attend and participate in health plan JOCs and other JOC
meetings related to propter coding and documentation.
Educate and mentor employed and contracted providers,
hospitalists and specialists on risk adjustment and documentation
Review charts to aid in the education process and discover
opportunities to improve accurate coding and documentation.
Develop ongoing chart review process to ensure continued high
standards in documentation and coding, as well as aid in developing
and monitoring inter-reviewer reliability testing.
Attend courses as needed to improve knowledge of coding and
Meet with market President/CMO/Leadership for department metric
Providers clear direction to achieve goals, creating an
environment that fosters team commitment and employee engagement.
Establishes practices, policies and operating procedures and
ensures alignment to objectives and strategy.
Ensures each level of the organization has the information and
data needed to achieve clinical performance goals. Holds self and
team accountable for results.
Understands effective communication across all levels of the
organization (both upward and downward) with the appropriate
message, the right tone and the appropriate level of impact.
Builds strong relationships with all levels of staff and leaders
to ensure connectivity to the business.
Recognizes problems and is able to make
recommendations/decisions on the best course of action to
remediate. Resourceful to create solutions using existing or
available resources based on knowledge of the organization and
level of execution effort.
Establishes measurement criteria and systems to track daily
processes, implementation of new initiatives and value
Perform other relevant job duties as assigned.
Job consists of unique and multi-dimensional work situations
where leadership and direction on variations from the norm is
expected. Job involves a high degree of complexity. Incumbent
oversees and or provides expert level guidance to a team of
professionals and is responsible for establishing practices and
procedures. Duties are performed independently with minimal
supervision and work is verified by results and favorable business
impact. Decisions are made within established departmental
guidelines, but also by using judgment for the best reasonable
outcome. Position has high visibility to Senior Leadership and
Executives through direct interaction and reporting.
Specific Job Skills and Experience:
Minimum 3 years of practicing medicine
Over 2 years of CMS-HCC operations experience
Over 3 years of supervisory experience.
Licensed physician in the state of Colorado, with knowledge of
Ability to engage contracted providers through indirect
ESSENTIAL TECHNICAL/MOTOR SKILLS:
Excellent range of knowledge with respect to the practice of
medicine. Ability to speak clearly and communicate with agencies,
other physicians and staff regarding patient care.
Ability to develop positive interaction with physicians,
administrators and co-workers in order to effectively care for the
MD or DO.
* Current and Unrestricted license to practice medicine in the
State of Colorado.
* Current and Unrestricted DEA
Job requires hours that may exceed 8 hours per day and/or 40
hours per week during times of peak activity. Evening meetings
and/or weekend work sometimes required to ensure timely project
completion. Moderate to high job pressure exists in the balancing
of several projects with conflicting and sometimes changing
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Posted Date 08/27/2020 Location Colorado Springs, Colorado,
United States of America Internal/External Category Nurse
Practitioners & Physician Assistants Job Type Full time
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Optum provides administrative and business support services to both
its owned and affiliated medical practices which are part of Optum.
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other characteristic protected by law. Optum and its affiliated
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