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Director Medicare Risk Adjustment
Crescent City Recruitment Group - San Diego, CA
Director Medicare Risk Adjustment
Crescent City Recruitment Group 
San Diego, CA 
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137
Director OF Risk Management
jobs221
jobs in
San Diego, CA
12
jobs at
Crescent City Recruitment Group
Job
Company
Description
Salary
Skills
Job Description
An outstanding opportunity with our client organization - National Managed care company with revenues over $1B.
We are seeking a Director of Medicare Risk to oversee the programs within the Medicare team. This is a 100% remote opportunity.
Primary duties may include, but are not limited to:
- Oversees daily operations of the retrospective and prospective review teams and programs and ensures the appropriate strategy, tactics and data capture processes are in place.
- Serves as the vendor liaison to ensure coordination of efforts, effective relationship management, cost-effectiveness, delivery of work product, quality of work, delivery of required training for internal associates and timely communication on all issues.
- Engages with enterprise functional areas to optimize identification of members with HCC conditions, facilitates efficient and effective interventions to ensure accurate and complete coding, and ensures at-risk members are referred to or engaged in care management programs.
- Audits the chart review outcomes provided by the risk adjustment vendor and audits provider coding trends to identify potential gaps.
- Works with PE&C to facilitate gap closure and consults on efforts that may improve provider engagement.
- Serves as a key member of the Medicare Risk Adjustment Management team in developing processes for multidisciplinary, matrixed teams to execute the strategic vision and achieve the goals and objectives of the organization related to revenue optimization.
- In consultation with VP of the Revenue Maximization team and Health Care Analytics, develops state-specific strategies and communicates recommendations to plan presidents.
- Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Experience
5 years' experience with Medicare or Medicaid risk adjustment processes or vendor management required
Must have 8 or more years of leadership experience
Must be able to travel up to 20% of the time within the West region
This job was posted on Thu Sep 22 2022 and expired on Thu Oct 06 2022.
Find out how you match this company
How do you assess and mitigate risks in a company?
Answer
I assess risks by conducting thorough risk assessments and identifying potential vulnerabilities. I then develop and implement strategies to mitigate those risks.
Can you provide an example of a risk management plan you have developed and implemented?
How do you ensure compliance with regulatory requirements in risk management?
About the Director OF Risk Management role
Accounting / Finance - Other Director OF Risk Management
As Directors of Risk Management, we are responsible for the implementation and ongoing execution of risk-related activities. It is our duty to manage risk processes. We work alongside a range of business units. We ensure that the plan’s populations are represented via the applicable risk program. Working towards addressing obstacles is our job. We manage work plans and activities across the risk management. Overseeing the day-to-day operational needs is our duty. We devise and implement strategies related to risk. We incorporate best practices to optimize risk scores. In this role, we develop reporting dashboards and KPIs while ensuring appropriate oversight and visibility.
Core tasks:
- identify and enhance existing processes that impact risk
- assess and build initiatives specific to the needs found in the provider network
- manage multiple vendors and contracts who provide risk services
- support reporting and progress to internal staff
- responsible for the timely submission of risk data
- provide support for all audits
137 Director OF Risk Management jobs in San Diego, CA
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