Market Director Population Health Quality and Risk
Job Overview
Employment Type
Full-time
Compensation
Type:
Hourly
Rate:
Range $52.00 - $77.00
Work Schedule
Flexible
Benefits
Health Insurance
Dental Insurance
Paid Time Off
Retirement Plan
Flexible work schedule
Professional Development
Remote work option
Job Description
CommonSpirit Health Southeast Value Hub (SEVH) is a consortium of multiple Clinically Integrated Networks (CINs) spanning Arkansas, Kentucky, Southeast Tennessee, Northeast Georgia, and Ohio. As a comprehensive healthcare organization, CommonSpirit Health operates to improve the quality of care, reduce unnecessary clinical costs, and enhance patient and provider experiences through advanced Value Based Agreements (VBAs) with both government programs such as CMS Medicare Shared Savings-Accountable Care Organization (MSSP-ACO) and Medicaid, as well as private insurers serving Medicare Advantage, fully insured, health insurance exchange, and self-insured commercial populations. With a stakeholder population of over 200,000 lives, SEVH is recognized as a leader... Show More
Job Requirements
- Bachelors degree in nursing required
- Current, unencumbered RN license in primary state of residence with ability to apply for multistate licensure (AR, KY, TN, GA) per the Nurse Licensure Compact
- At least 5 years leadership experience
- Extensive experience with Clinically Integrated Networks/Value Hub
- Experience with risk adjustment coding and value-based reimbursement models
- Knowledge of CMS, NCQA, ambulatory care, quality, and population health
- Must reside and work remotely from any state within Arkansas, Tennessee, Georgia, or Kentucky
Job Qualifications
- Bachelors degree in nursing
- Current, unencumbered RN license in primary state of residence with ability to apply for multistate licensure (AR, KY, TN, GA) per the Nurse Licensure Compact
- Minimum 5 years leadership experience
- Extensive experience in Clinically Integrated Networks/Value Hub operations
- Proven expertise with risk adjustment coding and value-based reimbursement models
- Knowledge of CMS regulations, NCQA standards, ambulatory care, quality management, and population health strategies
Job Duties
- Support quality, clinical practice, safety, risk coding, compliance, patient experience and health information management functions within the Value Hub
- Facilitate quality and patient experience performance across the Southeast Region Value Hub of CommonSpirit Health
- Demonstrate leadership in developing and implementing performance improvement plans and programs to meet strategic objectives
- Conduct provider and quality incentive programs in the Value Hub
- Manage a team of managers and personnel with varying critical organizational roles
- Serve as market liaison, interfacing with internal clinical leaders and external payer partners for quality and risk issues
- Implement a risk adjustment coding department in appropriate Arkansas and Kentucky CIN
- Educate providers to improve documentation and coding practices for accurate claims submissions and reimbursement
- Build relationships with managers and providers to establish trust and open communication on documentation best practices
- Participate in pilot programs for concurrent and retrospective review processes and assist in creating workflows and guidelines
- Support Risk Auditor Manager in working with HCC Risk auditors to maintain daily workflows and audit processes, ensuring auditors stay current on guidelines and ethics
- Lead weekly auditor roundtable discussions to enhance knowledge on complex documentation and coding areas
Job Qualifications
Experience
Expert Level (7+ years)
Job Location
We didn't receive the exact location for this job posting,
please contact the employer.
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