Provider Engagement & Risk Adjustment Lead

Intermountain Healthcare Inc.; Hagåtña (GU); Híbrido; USD 62.000 - 96.000; Tempo integral

Benefícios oferecidos por esta vaga

Benefits package

Hybrid work arrangement

Resumo da vaga

SelectHealth - Murray, Utah is seeking a Risk Adjustment Strategic Partner to coordinate risk adjustment, HEDIS and STAR gap closure, and healthcare utilization. This hybrid role requires travel for in-person meetings with provider organizations, and involves building strategic programs to cultivate value-based relationships in population health.

The candidate will analyze data, develop implementation plans, and advise executives on segment-specific strategies, with minimal supervision and

Qualificações

• Proficient at risk adjustment strategy for Medicare and ACA lines of business, including RAF score calculations, and ROI on engagement strategies
• Demonstrated understanding of HEDIS and STAR measures
• Knowledge of healthcare regulations and compliance requirements
• Familiarity with value-based care, provider incentive programs, P4P and quality programs
• Demonstrated ability to manage projects and teams, with a focus on achieving goals and objectives
• Excellent communication and interpersonal skills, with ability to build and maintain relationships with internal and external stakeholders
• Intermediate Excel skills, PowerPoint (MS Suite)
• Demonstrated ability to present to large groups and internal leadership
• Strong analytical skills and experience with data analysis and reporting.

Responsabilidades

• Accountable for working with provider groups to achieve annual goals, evaluate progress to goal, identify/analyze emerging business needs, and conduct effective provider outreach and engagement for performance improvement
• Develops strategies to address gaps in care and provides solutions for actionable clinic and provider opportunities. Monitors and analyzes the effectiveness of programs, processes, infrastructure, and makes changes to improve results
• Designs and implements reporting across the risk adjustment organization and with external partners (e.g., Kidney Team, Group Medicare)
• Supports HQRI strategic engagements, representing risk adjustment across new member initiatives and PPO strategies
• Fosters relationships with providers and clinical leadership, internally and externally
• Manages high-priority initiatives effectively, demonstrating a proactive approach and self-guided leadership
• Works individually and as part of a team to articulate and coach provider partners in the complexities of value-based contracts, quality measures, risk adjustment strategies and aid provider groups through the effective use of data reports
• Leads operational strategies to meet the objectives of Select Health and collaborates with health plan’s partners and leads and facilitates implementation of services in collaboration with Select Health team members and partnerships
• Ensures each clinic has appropriate interoperability with Select Health through data transfer and EMR accessibility and ensures efficient and effective use of resources
• Coordinates resolution of any issues or concerns that may arise between the clinic organization and Select Health
• Collaborates with internal stakeholders to identify and implement risk adjustment initiatives that align with the organization's goals and objectives
• Ensures compliance with regulatory requirements and industry best practices related to population health management
• Manages vendor relationships that support risk adjustment activities
• Is accountable to Select Health leadership in reporting monthly KPI’s for specific groups, regions, lines of business and states

Conhecimentos

Risk Adjustment

Relationship Building

Performance Improvements

Management Reporting

Quality Measurements

Data Interpretations

Analytical Thinking

Written Communication

HEDIS

Accountability

Data Reporting

Presentations

Formação

Bachelor’s degree in healthcare administration or business administration

Five years of health plan/provider administration experience

Ferramentas

Excel

PowerPoint

Descrição da vaga

SelectHealth - Murray, Utah is seeking a Risk Adjustment Strategic Partner to coordinate risk adjustment, HEDIS and STAR gap closure, and healthcare utilization. This hybrid role requires travel for in-person meetings with provider organizations, and involves building strategic programs to cultivate value-based relationships in population health.

The candidate will analyze data, develop implementation plans, and advise executives on segment-specific strategies, with minimal supervision and