Director,Regional Risk Adjustment
Posted on: March 28, 2020
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.
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
* Present HCC/RAF performance results and findings to important
* Participate in supporting the Risk Adjustment Data Validation
* 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
* 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
* 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
* Departments to ensure deliverables are accomplished as
* 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
* 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
* 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
* 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
Didn't find what you're looking for? Search again!