Risk Adjustment Medical Director (Physician #)
Posted on: January 15, 2021
Full time Risk Adjustment Medical Director - Roma Location,
Albuquerque New MexicoOverview of Position: Responsible for
administration and oversight of the medical and clinical activities
of employed and contracted providers as well as various operations
functions within assigned market(s) to ensure appropriate practices
related to risk adjustment activities, HEDIS measures, and any
appropriate gaps in care. The Medical Director works
collaboratively with all facets of the business and business
leadership including Risk Adjustment, Clinical Education team,
other Medical Directors and leaders, coding department, physicians,
site administrators and operations, to educate and improve accurate
coding and documentation skills, leading to a more complete patient
record.The Risk Adjustment Medical Director is responsible to lead
efforts to improve risk adjustment programs including accurate
documentation and coding and to be accountable for those
improvements and outcomes. The Director acts as a resource for
national and network leadership as well as physicians, specialists,
and hospitalists.The Risk Adjustment Medical Director is further
responsible for keeping up to date on changes in the Medicare risk
adjustment model or other documentation requirements.Essential
- Coordinates implementation of programs designed to ensure all
diagnosed codes and conditions are properly supported by
appropriate documentation in patient chart. Programs include, but
are not limited to, training and educational activities and
coordination of random targeted documentation audits and concurrent
follow up feedback.
- Coordinates with clinician leadership to ensure the clinical
aspects of risk adjustment programs and best practices are
communicated to group and IPA providers.
- Oversees preparation and implementation of clinical correlation
- Interfaces with operational leadership to assist in
identification of operational and clinical best practices in
maximizing patient visits, re-evaluation rates and accurate and
proper coding; coordinates the dissemination of best practices to
sites, clinicians and IPAs providers / support staff.
- Coordinates sharing of best practices related to risk
adjustment activities with other regions within the network.
- *Serve as a resource for the market, network, and national
operations on proper coding and documentation.
- Attend and participate as requested in relevant meetings that
pertain to coding and documentation.
- *Attend and participate in health plan JOCs and other JOC
meetings related to propter coding and documentation.
- Educate and mentor employed and contracted providers,
hospitalists and specialists on risk adjustment and documentation
- Responsible for onboarding, ongoing, and targeted education of
all physicians on coding and documentation for Medicare risk
- Accountable for the overall improvement and performance in risk
- Attend market, network and clinic site meetings as appropriate
to present material on coding & documentation.
- Review charts to aid in the education process, and discover
opportunities to improve accurate coding and documentation.
- Develop ongoing chart review process to ensure continued high
standards in documentation and coding, as well as aid in developing
and monitoring inter-reviewer reliability testing.
- Attend courses as needed to improve knowledge of coding and
- Meet with market President/CMO/Leadership for department metric
- Consistently exhibits behavior and communication skills that
demonstrate Optum's commitment to superior customer service,
including quality, care and concern with each and every internal
and external customer.
- Accountable for clear understanding of mission and goals the
department. Provides clear direction to achieve goals, creating an
environment that fosters team commitment and employee engagement.
Establishes practices, policies and operating procedures and
ensures alignment to departmental objectives and strategy.
- Ensures each level of the organization has the information and
data needed to achieve clinical performance goals. Holds self and
team accountable for technical abilities performance results.
- Understands effective communication across all levels of the
organization (both upward and downward) with the appropriate
message, the right tone and the appropriate level of impact.
- Builds strong relationships with all levels of staff and
leaders to ensure connectivity to the business.
- Recognizes problems and is able to make
recommendations/decisions on the best course of action to
remediate. Resourceful to create solutions using existing or
available resources based on knowledge of the organization and
level of execution effort.
- Establishes measurement criteria and systems to track daily
processes, implementation of new initiatives and value
- Other duties as assignedEducation: Required: Fully licensed as
a physician in the state of New Mexico.Experience:Minimum 3 years
of practicing medicine
- Over 2 years of CMS-HCC operations experience
- Over 3 years of supervisory experience.
- Licensed physician in the state of New Mexico with knowledge of
- Ability to engage contracted providers through indirect
influenceKnowledge, Skills, Abilities:
- Thorough understanding of medical group business models and
- Ability to strategically lead regionally to ensure accurate
diagnostic codes in order to maximize risk adjustment (RAF).
- Experience with identifying Medicare risk adjustment and
presenting findings to client/clinicians; Working knowledge of
managed care and value based medicine
- Excellent understanding of medical group financial concepts,
including revenue cycle, physician compensation models, and
preferably including managed care financial concepts (capitation,
- Helping set agendas/strategies and leading multifaceted teams
of Physician Business Managers, Risk Adjustment dyads, and Quality
- Developing and cascading clinical outcome/improvement messaging
to business units to foster tighter working culture.
- Excellent communication skills, both verbal and written.
Ability to comfortably use Microsoft Word, Excel, and
- Current MD/DO unrestricted medical license in the state of New
Mexico Board Certified or in the process of obtaining certification
unless granted an exemption by Credentialing Committee.
- New Mexico Pharmacy/DEA Registration if applicable to
- Current BLS CertificationCareers with Optum. Here's the idea.
We built an entire organization around one giant objective; make
health care work better for everyone. Optum, part of the
UnitedHealth Group family of businesses, brings together some of
the greatest minds and most advanced ideas on where health care has
to go in order to reach its fullest potential. For you, that means
working on high performance teams against sophisticated challenges
that matter. Here you'll find incredible ideas in one incredible
company and a singular opportunity to do your life's best
work.(SM)Diversity creates a healthier atmosphere: Optum and its
affiliated medical practices are Equal Employment
Opportunity/Affirmative Action employers and all qualified
applicants will receive consideration for employment without regard
to race, color, religion, sex, age, national origin, protected
veteran status, disability status, sexual orientation, gender
identity or expression, marital status, genetic information, or any
other characteristic protected by law. Optum and its affiliated
medical practices is a drug-free workplace. Candidates are required
to pass a drug test before beginning employment. Keyphrases: health
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Keywords: Optum, Albuquerque , Risk Adjustment Medical Director (Physician #), Executive , Albuquerque, New Mexico
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