ArcadiaRecruiter Since 2001
the smart solution for Arcadia jobs

Director,Regional Risk Adjustment

Company: Optum
Location: Arcadia
Posted on: March 28, 2020

Job Description:

Job Summary

You will create plans and outcomes related to Risk Adjustment. Priorities include being the accountable leader for the region, as well as providing high-level operational direction. In collaboration with the El Segundo central Risk Adjustment Department, multiple partners, the Regional Director will play an essential role in performance improvement, conceiving the approach for implementation, and managing deployment of risk adjustment activities and programs.

Knowledge/Skills/Abilities

You will direct the operations for multi-year, large-scale RAF Projects. Programs may be related to business process/technology migrations, process-design, program deployment and new plans related to RAF projects. Oversee the development of the RA program across all important areas while specifically ensuring essential metrics and timelines are met within your region.

* Be an expert on Risk Adjustment, understanding the intricacies of the CMS Medicare model to guide compelling strategies.
* Collaborate with the VP of Risk Adjustment to help develop a clear strategy with important performance indicators. Has knowledge in risk adjustment to participate in Joint Operations Committees and in discussions with senior leadership teams.
* Help with the analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects.
* Help with the development of ad hoc reports and presentations for risk adjustment projects.
* Assist end-users to gather reporting requirements and analyze internal reporting tools.
* Support and oversee outreach efforts on Risk Adjustment Education based on review of pre-selected charts coupled with data management, data reporting and provider scorecards.
* Propose opportunities on strategies to ensure company goals are met. Ensures early detection of major risks and interdependencies.
* Present HCC/RAF performance results and findings to important internal leadership.
* Participate in supporting the Risk Adjustment Data Validation Audits.
* Collaborate on vendor performance in the region, providing feedback, analysis and outcomes supporting goals.
* Communicate with regional Senior Leadership Teams, including Regional Vice Presidents, CHAPs, and other team members about important deliverables, barriers and escalation that need immediate attention.
* Demonstrate leadership and diverse teams that oversee implementation of risk adjustment interventions.
* Interpret data and financial metrics.
* Direct responsibility for the oversight, hands-on participation and delivery of large-scale projects/programs.
* Organize development of enterprise level planning and program objective setting.
* Provide strategic input on the development of program roadmaps, action plans, work plans and timelines.
* Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies.
* Ensure communication between the team members, business leaders and diverse teams.
* Maintain collaborative working relationships with Claims, Enrollment, IT, our essential collaborators and contracted vendors.
* Departments to ensure deliverables are accomplished as promised.

Job Qualifications

Required Education

Bachelor's Degree

Required Experience

* 8-10 years of experience in Managed Care, Payer/Provider/Health Plan or Health system management.
* 7 years of experience in Medicare Advantage.
* 5-7 years risk adjustment experience with expertise in one or more risk adjustment markets; Chart Review or In-Home assessment or Provider education or Prospective programs or member engagement or submissions.
* 3-5 years of experience with a large medical group or IPA
* Leadership experience fostering a high performing team, building relations with physicians and staff at all levels.
* Track record for achieving performance results.
* Excellent interpersonal, with the ability to inspire and engender trust across all levels of an organization.
* Are with bias for and problem resolution ability to be a team player.

Preferred Education

Master's Degree

Preferred Experience

* Understand Risk Adjustment Factor methodology and approaches to support accurate coding.
* Experience and fluent in revenue cycle management systems and other healthcare financial performance.
* Experience with payers and billing including knowledge of ICD-10 coding guidelines.
* Medical group/IPA experience, having and partner with multiple team members and executives.

What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)

Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, 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: OptumCare 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. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Arcadia , Director,Regional Risk Adjustment, Executive , Arcadia, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Medical Coding Manager - Physian Services
Description: PHYSICIAN CODING MANAGERThe Coding Manager is responsible for planning, organizing and supervising the coding department to provide optimum coding in accordance with procedures, goals and standards oversees (more...)
Company: Nexus Staffing Group
Location: Los Angeles
Posted on: 04/1/2020

Interim Financial Project Manager (Project)
Description: Our client in the healthcare industry is looking for an Interim Financial Project Manager to join their team in Los Angeles County br br Job Description: br br ul br li Responsible for more (more...)
Company: Century Group (CA)
Location: Los Angeles
Posted on: 04/1/2020

Manager of Corporate FP&A
Description: Our client in the entertainment industry is looking for an Manager of Corporate FP A to join their team in Los Angeles County br br Job Description: br br ul br li Manage the annual budget (more...)
Company: Century Group (CA)
Location: Los Angeles
Posted on: 04/1/2020


UX Design Manager
Description: iZotope is looking for an experienced User Experience Manager to join our growing Design team. The successful candidate will drive the user experience of iZotope's award-winning music production desktop (more...)
Company: iZotope
Location: Los Angeles
Posted on: 04/1/2020

Interim Payroll Manager (Project)
Description: Our client in the service company industry is looking for an Interim Payroll Manager to join their team in Los Angeles. br br Job Description: br br ul
Company: Century Group (CA)
Location: Los Angeles
Posted on: 04/1/2020

Director of Social
Description: PurposeThe Director of Social leads a highly talented team in the development of breakthrough content and has a proven track record of building and growing digital first divisions through the nurturing (more...)
Company: Wild Card Media
Location: Los Angeles
Posted on: 04/1/2020

Application Lifecycle Management (ALM) Engineer
Description: As a member of the Application Services unit, the Application Lifecycle Management ALM Engineer develops and supports IT Services' application development lifecycle management processes and tools. The (more...)
Company: UCLA Information Technology Services
Location: Los Angeles
Posted on: 04/1/2020

Facilities Project Manager Sr
Description: Job SummaryCoordinates and directs facilities planning, renovation, and relocation projects for the Getty. Develops space requirements and design criteria with architects to ensure efficient space management (more...)
Company: J. Paul Getty Trust
Location: Los Angeles
Posted on: 04/1/2020

Assistant Manager, Records Management
Description: Tuesday, February 25, 2020 br br The Assistant Manager will be responsible for supporting the Records Management Manager in leading daily work activities of the department, including intake, tracking (more...)
Company: Motion Picture Industry Pension & Health Plans
Location: Los Angeles
Posted on: 04/1/2020

Associate Director of Development
Description: Overview of AJWS br American Jewish World Service AJWS is the leading Jewish organization working to pursue justice and fight poverty in the developing world. By supporting hundreds of social change (more...)
Company: American Jewish World Service
Location: Los Angeles
Posted on: 04/1/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Arcadia RSS job feeds