THIS POSITION REQUIRES WASHINGTON STATE RESIDENCY

Employees must establish a residence in Washington State within 30 days of their first day of employment and must maintain a residence in Washington State during their employment with PSW. If a position is eligible to telework, work performed while teleworking must be performed in Washington State.

Summary / Objective:

Operationalize provider engagement initiatives to drive performance improvements related to Risk Adjustment, accurate condition documentation, and Medicare Stars. The Risk and Quality Manager is responsible for deploying actionable campaigns to enable provider performance, including analyzing performance data, partnering with the MCC Director of Risk Adjustment to set targets, and communicating improvements.

Essential Functions:

• Engages with provider Network(s) to apply industry best practices related to risk adjustment and coding capture. Identifies barriers and offers tailored solutions based on group cultures and competencies.
• Improves provider organization performance through data analysis, knowledge of best practices, and development and execution of interventions in collaboration with peers and leaders of contracted healthcare delivery systems.
• Serves as a subject matter expert on MA and ACO programs and objectives such as quality, risk adjustment, and other Medicare programs.
• Stays informed and updated on measures, program changes and quality gap closure processes.
• Establishes credibility as a trusted advisor and resource to influence positive change while imparting a great company image and professional demeanor.
• Participates in internal workgroups to support development of effective member and provider network-directed interventions; coordinates interventions with internal stakeholders.
• Monitors Provider progress and creates awareness of course corrections when needed.
• Conducts retrospective chart reviews and provides actionable information to providers to ensure accuracy, compliance and best practice.
• Monitors supplemental data exchange strategy between provider groups and PSW to support the improvement in performance measures for the Stars program.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Assesses and communicates project status, key business risks and vulnerabilities to leadership.
• Recommends and implements appropriate action steps and coordinates with internal teams to follow through to close action plans.
• As a Network Management team member - lead, participate, and contribute to internal committees/workgroups as assigned; acts as a mentor to others within the overall team.
• Creates a sense of urgency within the organization and translates quickly evolving directions into action.
• Adheres to all quality, compliance and regulatory standards

THIS POSITION REQUIRES WASHINGTON STATE RESIDENCY

Employees must establish a residence in Washington State within 30 days of their first day of employment and must maintain a residence in Washington State during their employment with PSW. If a position is eligible to telework, work performed while teleworking must be performed in Washington State.

Required Work Experience:

• Familiarity with Medicare Advantage and its business model
• Experience at a provider organization in population health or in provider relations/engagement at a plan
• Demonstrated acumen identifying problems, developing solutions, and implementing a chosen course of action to resolve issues and build consensus among groups of diverse stakeholders.
• Ability to develop and drive new initiatives from concept through execution, including developing, managing and leading complex projects.
• Demonstrated ability to develop relationships quickly and leverage working relationships to drive performance outcomes.
• Excels at working with all levels of staff, within and external to the organization, to achieve goals.
• Strong written and verbal communication and facilitation skills, excellent presentation and public speaking skills (formal and informal)
• Demonstrated proficiency with collaboration tools (Teams), presentation, word processing, CRM, reporting and spreadsheet software used to create and maintain databases, and documents.
• Successful working independently as well as being a strong team leader and contributor.
• Identifies and distills multiple inputs into priorities and drives results
• Ability to work in a high-pressure environment and effectively manage conflict and ambiguity

Preferred Education and/or Work Experience:

• Bachelor’s or Master’s Degree in healthcare, science, business or related field, or equivalent combination of education and experience.
• 10 years’ experience in one of the following areas: population health management, Provider contracting and reimbursement, managed care, healthcare delivery, risk adjustment, Stars
• Familiarity w/value-based care, including shared savings/risk models. Knowledge of provider coding, documentation practices, reimbursement, and contract methodologies
• Demonstrated analytical and problem-solving ability with the skills to interpret and present complex data to all levels of stakeholders internal and external