Program Manager II, Risk Adjustment
3 weeks ago
Who we are
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:
- Strive to apply an equity lens to all our work.
- Reduce health disparities.
- Become an anti-racist organization
- Create an equitable work environment.
To be successful in this role, you:
- Bachelor’s degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or other relevant academic field, or an equivalent combination of education and highly relevant experience preferred.
- PMP, Agile Professional, or other formal project management certification preferred.
- 3+ years experience in program management, preferably related to HEDIS, Risk Adjustment, or general healthcare.
Essential functions and Roles and Responsibilities:
- Serve as single point of accountability for program management of annual audits, working directly with internal teams, third party auditors and third-party vendors to ensure project meets goals and objectives. Assign team responsibilities and ensure appropriate internal resources assigned to guarantee project success.
- Develop and maintain detailed project plans to include milestones, tasks, and target/actual dates of completion. Track team adherence to project timelines and clear barriers to team progress, including team conflict. Escalate risks and impasses to leadership.
- Lead accurate and complete critical statutory data submissions related to Risk Adjustment.
- Lead the identification of data issues and efforts related to improving data generation and flow throughout the organization, including reporting process and protocol.
- Lead the identification of improvement opportunities in all aspects of risk adjustment, driving improved quality performance. Communicate opportunities to business owners.
- Develop program knowledge to support key strategic opportunities and improvement strategies.
- Communicate regularly with project stakeholders regarding status of the project, issues impeding progress, and recovery plans for off-track items/tasks.
- Establish and maintain effective professional relationships with key upstream and downstream partners
Knowledge, Skills, and Abilities:
- Advanced working knowledge of CMS-HCC, ACA-HCC, or CDPS technical specifications
- Experience in program development, product development, process improvement and evaluation strongly preferred.
- Knowledge of and experience leveraging change management principles, practices, and methodologies
As part of our hiring process, the following criteria must be met:
- Complete and successfully pass a criminal background check
Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
- Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
- Vaccination requirement (CHPW offers a process for medical or religious exemptions)
- Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
Compensation and Benefits:
The position is FLSA Non-Exempt (Exempt) and is (not) eligible for overtime. Based on market data, this position grade is (X) (see full range below) and has a (X%) annual incentive target based on company, department, and individual performance goals.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match
- Employee Assistance Program and Mental Fitness app
- Financial Coaching, Identity Theft Protection
- Time off including PTO accrual starting at 17 days per year
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty
Sensory/Physical/Mental Requirements:
Sensory*:
Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*:
- Extended periods of sitting, computer use, talking, and possibly standing
- Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
Mental:
Frequent decision-making.
Work Environment:
Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
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