Company:
AHI agilon health, inc.
Job Posting Location:
Columbus, OH
Job Title:
Regional Director, Risk Adjustment and Quality
Job Description:
Position Summary:
The Regional Director, Risk Adjustment and Quality is responsible and accountable for the planning, execution, and coordination of multiple in-market Risk Adjustment and Quality programs. Collaborates and partners with the platform Risk Adjustment and Quality divisions, the market colleagues, and peers to lead the Risk Adjustment and Quality teams to ensure performance, engagement, and compliant execution of the program. Works closely with and frequently engages the leadership of and the providers within the risk bearing entity to ensure alignment on all aspects of the program.
Essential Job Functions:
- Leads the Risk Adjustment and Quality program in 3 or more markets (within the same or different states)
- Develop and implement the markets risk adjustment and Quality programs.
- Collaborates and consults with the platform Risk Adjustment and Quality division and the markets leadership teams to implement the markets risk adjustment and quality programs.
- Work with the market’s leadership teams on developing plans for provider and member engagement strategies.
- Oversee the markets performance and ensure all the markets success with programs.
- Track, trend, and report all the market’s performance to platform and the local market leadership. Create and implement performance improvement plans when needed.
- Collaborate with the market’s Medical Directors to optimize engagement and performance of the providers.
- Holds regular meetings with Medical Directors and POD leaders to review performance metrics and develop strategies to engage providers and optimize performance.
- Work together with the other market Directors of Risk Adjustment and Quality to ensure standardization where applicable and the sharing or development of best practices for the program.
- All other duties as assigned.
Other Job Functions:
- Understand, adhere to, and implement the Company’s policies andprocedures.
- Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
- Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
- Engage in excellent communication which includes listening attentively and speaking professionally.
- Set and complete challenging goals.
- Demonstrate attention to detail and accuracy in work product.
Required Qualifications:
Minimum Experience
- 10+ years of experience in managed care or the health care industry with focus on government programs strongly preferred.
- Must have firm understanding of CMS HCC Risk Adjustment Model
- Must have understanding of HEDIS and Medicare Stars program.
- Must have worked with previous risk adjustment or quality program teams.
- Must be analytical.
- Must have excellent collaboration and communications skills and can influence change across teams.
- Understand medical records or have ability to read clinical records.
Education/Licensure:
- Bachelor’s degree required.
- Master’s degree preferred.
Location:
Columbus, OH
