AVP Stars and Risk Adjustment National Medical Director - Meridian, United States - CLevelCrossing

CLevelCrossing Meridian, United States

1 week ago

Description

AVP Stars and Risk Adjustment National Medical Director

Location
Meridian, ID, United States
Posted on
Apr 28, 2023
Apply for this job

your email:

upload resume:
Profile
Job Information
Humana
AVP, Stars and Risk Adjustment National Medical Director
in
Meridian
Idaho
Description

The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can contribute to Humana's national planning and operations for Risk Adjustment, Stars, and Interoperability.

Specifically, this role will carry a set of individual contributor and leadership responsibilities.
As an individual contributor, this role will: 1) inform and support HQRI's provider strategy across Stars, RA, and Interoperability, 2) serve as a coding expert to manage escalations or establish compliant policies, and 3) contribute as a clinical industry representative.

As a leader, this role leads HQRI's Provider Support team (PST) that drives national provider education strategy and operations along with provider communication operations.

HQRI is an organization with over 900 associates that leads Humana'sStars, Risk Adjustment and Interoperability strategy, operations, and performance nationally.

This role relies on medical background, business acumen, and industry-standard clinical / coding guidance to ensure physician and healthcare provider plans, education, reporting and materials are accurate and consistent across the enterprise to support regional and corporate strategic initiatives.

Responsibilities
The Associate Vice President (AVP), Stars and Risk Adjustment National Medical Director leads key strategic and operational functions.

In collaboration with corporate stakeholders and regional teams, this role is responsible for supporting corporate and regional strategies for physician and healthcare provider education or operations for Risk Adjustment and Stars.

In addition, the position provides supportive clinical and coding expertise across the teams in HQRI. Lastly, this leader will be instrumental in supporting interoperability efforts.

This position reports the Vice President of Strategy Advancement in the Healthcare Quality Reporting and Improvement organization (HQRI) and collaborates significantly with the HQRI Senior Leadership Team across its programs.

This is a remote position with travel expectations up to 25%.
Major responsibilities include
Inform HQRI's provider strategy and increase adoption of Humana's Stars, MRA, and interoperability strategy and programs
Lead a team/organization of 10 associates across three functions: Education of Humana's Market-based associates on how to drive accurate reporting through provider education; Provider communications; policies and procedures aligned to those functions
Serve as HQRIs clinical industry representative (e.g., Conferences; national vendor or provider partners)
Serve as a coding expert, which may include working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates
Required Qualifications
MD or DO degree
A current and unrestricted license in at least one jurisdiction
Board Certified in an approved ABMS Medical Specialty
Excellent communication skills, both written and verbal
5 years of established clinical experience
Knowledge of the managed care industry including Medicare, Medicaid and / or Commercial products
Must be passionate about healthcare quality and contributing to an organization focused on maintaining accuracy of coding and documentation to capture the true health status of our members thru risk adjustment initiatives
Experience with quality assurance and/or regulatory compliance
Travel up to 25%

Preferred Qualifications:
Certification in diagnosis coding (must receive AAPC certification within one year of hire)
Ability to help develop and use data and analytics to drive sustainable results
External communications for physicians and healthcare providers
Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding
Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
Working knowledge of risk adjustment concepts
Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialty
Detail oriented and effective listener
Experience with Stars, including HEDIS, CAHPS and HOS
Prior experience in a business function or business consulting role

Additional Information:
Vaccine Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters.

Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field
Scheduled Weekly Hours
40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion.

We also provide free language interpreter services. See our

#J-18808-Ljbffr

Medical Director Claims Management

1 week ago

Idaho State Job Bank Meridian, United States

Medical Director--Claims Management at Humana in Meridian, Idaho, United States Job Description Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or re ...
Veterinary Medical Director

2 weeks ago

All Valley Animal Care Center & All Valley Resort Meridian, United States

· Position at All Valley Animal Care Center & All Valley Resort · Thrive Pet Healthcare is looking to hire a Medical Director to join the team at All Valley Animal Care Center in Boise, Idaho · The Medical Director reports to the Regional Director and is a key leader in the ho ...
Medical Director

1 week ago

Centurion Health Kuna, United States

Job Details · Job Location · ID, Kuna - Idaho State Correctional Center - Kuna, ID · Position Type · Full-Time · Education Level · Professional Degree · Job Shift · Day · Job Category · Medical Physician & Advanced Practice Provider · Description · $20,000 BONUS FOR JOI ...
PT Dental Medical Director/Case Review

2 weeks ago

Idaho State Job Bank Meridian, United States

PT Dental Medical Director/Case Review - R at Blue Cross of Idaho in Meridian, Idaho, United States Job Description Blue Cross of Idaho is looking for a Part-Time Medical Director to provide dental expertise to the organization to ensure effective utilization management review ac ...
Medical Director

1 week ago

Centurion Health Boise, United States

Job Details · Job Location · ID, Boise - Idaho Regional Office - Boise, ID · Position Type · Full-Time · Education Level · Professional Degree · Job Shift · Day · Job Category · Medical Physician & Advanced Practice Provider · Description · Centurion Health is proud to ...
Site Medical Director

1 week ago

Centurion Health Kuna, United States

Overview: · Centurion Health is proud to be the new provider ofcomprehensive healthcare services to the Idaho Department of Correction. · We are currently seeking a full-time Site Medical Director to join our team at South Idaho Correctional Institution located 20 minutes sout ...
Medical Director DMEPOS

1 week ago

Optum Boise, ID, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel ...
Medical Director DMEPOS

1 week ago

UnitedHealth Group Boise, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel ...
Medical Director DMEPOS

1 week ago

Optum Boise, ID, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel ...
Psychiatric Medical Director

7 hours ago

FCS, Inc. Boise, United States

Out Patient Psychiatry Medical Director needed for the region s most advanced Trauma Center, which recognizes their dedication to providing the highest quality, most optimal care for all critically ill and injured patients. NO call No Weekends Full-time OP opportunity. Competitiv ...
System Medical Director Research

1 week ago

St. Luke's Health System Boise, United States

Overview · At St. Luke's Health System, our Research Department is at the forefront of advancing medical knowledge and improving patient care. We are committed to conducting innovative research that translates into real-world solutions and transformative healthcare practices. Our ...
Medical Director: Documentation

1 week ago

Trinity Health Boise, United States

**Job Requirements** · 1. M.D / D.O. degree required. · 2. A minimum of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. · 3. Demonstrated teamwork, performance analysis, presentation, interpersonal, facilitat ...
Research System Medical Director

6 days ago

St. Luke's Health System Boise, United States Full time

Overview · At St. Luke's Health System, our Research Department is at the forefront of advancing medical knowledge and improving patient care. We are committed to conducting innovative research that translates into real-world solutions and transformative healthcare practices. Ou ...
Medical Director

2 weeks ago

Centurion Health Kuna, United States

Job Details · Job Location · ID, Kuna - Mountain View Transformation Center - Kuna, ID · Position Type · Part-Time · Education Level · Professional Degree · Job Shift · Day · Job Category · Medical Physician & Advanced Practice Provider · Description · Centurion Health ...
Medical Director

2 weeks ago

Centurion Health Boise, United States

Job DetailsJob LocationID, Boise - Idaho Regional Office - Boise, IDPosition TypeFull-TimeEducation LevelProfessional DegreeJob ShiftDayJob CategoryMedical Physician & Advanced Practice ProviderDescriptionCenturion Health is proud to be the provider ofcomprehensive healthcare ser ...
Medical Director

2 weeks ago

Humana Boise, United States

Location field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · Humana · Medical Director - Gulf South Region · in · Boise , · Idaho · B ...
Research System Medical Director

1 week ago

St. Luke's Health System - Boise, ID Boise, United States

At St. Luke's Health System, our Research Department is at the forefront of advancing medical knowledge and improving patient care. We are committed to conducting innovative research that translates into real-world solutions and transformative healthcare practices. Our dedicated ...
System Medical Director Research

1 week ago

Idaho State Job Bank Boise, United States

System Medical Director Research at St. Luke's Health System in Boise, Idaho, United States Job Description Overview At St. Luke's, our patients come from all walks of life and so do we We strive to foster an environment that embraces our employees' unique strengths, experiences, ...
Regional Medical Scientific Director

1 week ago

Idaho State Job Bank Boise, United States

Regional Medical Scientific Director Immunology (GI) (Remo at Merck in Boise, Idaho, United States Job Description Job Description We are seeking a Growth and Improvement minded Regional Medical Scientific Director Immunology Lower GI Tract Immunology that can help drive our Stra ...
Behavioral Health Medical Director

1 week ago

Idaho State Job Bank Boise, United States

Behavioral Health Medical Director - Southwest Medicaid at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operat ...