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Medical Director, Risk Adjustment

Company: OptumCare
Location: Colorado Springs
Posted on: September 16, 2020

Job Description:

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 record.

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, and hospitalists.

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.

Essential Functions/Responsibilities:

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 adjustment.

Accountable for the overall improvement and performance in risk adjustment metrics.

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 studies.

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 requirements.

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 documentation.

Meet with market President/CMO/Leadership for department metric updates.

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 creation.

Secondary Functions:

Perform other relevant job duties as assigned.

Job Scope:

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 the coding/billing/documentation

Ability to engage contracted providers through indirect influence

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.

INTERPERSONAL SKILLS

Ability to develop positive interaction with physicians, administrators and co-workers in order to effectively care for the patient.

Education:

MD or DO.

LICENSURE:

* Current and Unrestricted license to practice medicine in the State of Colorado.

* Current and Unrestricted DEA

Job Conditions:

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 deadlines.

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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

Meet Our Empowered Medical Professionals At Optum, we are transforming health care with innovative care models and technology and pushing the boundaries of what’s possible in health care. Help us push aside the limits and discover endless opportunities to make an impact and start doing  your life's best work. SM

Don't have time to apply or don't see the right role yet?

Optum is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, Optum provides administrative and business support services to both its owned and affiliated medical practices which are part of Optum. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. Optum’s support services do not interfere with or control the practice of medicine provided by the medical practices of any of their physicians.

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: OptumCare, Colorado Springs , Medical Director, Risk Adjustment, Other , Colorado Springs, Colorado

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