AVP Stars and Risk Adjustment National Medical Director
Location : Chicago, IL, United States
Employment Type : Full-Time
Posted on : Apr 28, 2023
Profile
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.
This role carries individual contributor and leadership responsibilities.
Responsibilities
- Inform and support HQRI's provider strategy across Stars, RA, and Interoperability.
- Serve as a coding expert to manage escalations or establish compliant policies.
- Contribute as a clinical industry representative.
- Lead HQRI's Provider Support team (PST) to drive national provider education strategy and operations.
- Collaborate with corporate stakeholders and regional teams to support corporate and regional strategies for physician and healthcare provider education or operations for Risk Adjustment and Stars.
- Provide supportive clinical and coding expertise across the teams in HQRI.
- Support interoperability efforts.
This role reports to 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%.
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.
- Passionate about healthcare quality and contributing to an organization focused on maintaining accuracy of coding and documentation to capture the true health status of members through risk adjustment initiatives.
- Experience with quality assurance and / or regulatory compliance.
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.
- 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.
- Working knowledge of risk adjustment concepts.
- 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
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 Inc.
Below, you will find a complete breakdown of everything required of potential candidates, as well as how to apply Good luck.
Website : http : / / www.humana.com
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