AVP Stars and Risk Adjustment National Medical Director
Location: Newport, RI, United States
Posted on: Apr 28, 2023
Profile:
The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive to contribute to Humana's national planning and operations for Risk Adjustment, Stars, and Interoperability. This role carries both 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) that drives national provider education strategy and operations.
- Ensure physician and healthcare provider plans, education, reporting, and materials are accurate and consistent.
Major Responsibilities:
- Inform HQRI's provider strategy and increase adoption of Humana's Stars, MRA, and interoperability strategy and programs.
- Lead a team of 10 associates across three functions: Education, Provider communications, and policies and procedures.
- Serve as HQRI's clinical industry representative at conferences and with national vendor or provider partners.
- Serve as a coding expert, including working through escalations on coding disputes and policy development.
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 coding accuracy.
- 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 develop and use data and analytics to drive sustainable results.
- External communications for physicians and healthcare providers.
- Prior experience leading teams focusing on medical record documentation and diagnosis coding accuracy.
- Medical management experience with health insurance organizations, hospitals, and other healthcare providers.
- Working knowledge of risk adjustment concepts.
- Experience with Stars, including HEDIS, CAHPS, and HOS.
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 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.
#J-18808-Ljbffr
