Current jobs related to Manager, Risk Adjustment Clinical Quality Documentation - Oakland - Brown & Toland
-
Director of Risk Adjustment Compliance
2 weeks ago
Oakland, California, United States Kaiser Permanente Full timeJob SummaryThe Director of Risk Adjustment Compliance will oversee and maintain a high-quality, effective, best practices risk adjustment compliance program to prevent and detect violations of law and other misconduct and to promote ethical practices and a commitment to compliance with applicable federal, state, and local laws, rules, regulations, and...
-
Director, Risk Adjustment Compliance Specialist
2 weeks ago
Oakland, California, United States Kaiser Permanente Full timeJob Summary:The primary purpose of the Director, Risk Adjustment Compliance is to provide oversight and maintenance of a high-quality, effective, best practices risk adjustment compliance program to prevent and detect violations of law and other misconduct and to promote ethical practices and a commitment to compliance with applicable federal, state, and...
-
Director of Risk Adjustment and Compliance
11 hours ago
Oakland, California, United States Altais Health Solutions Full timeAbout the RoleWe are seeking a highly skilled and experienced Director of Risk Adjustment and Compliance to join our team at Altais Health Solutions. As a key member of our organization, you will be responsible for ensuring the accuracy and completeness of our risk adjustment and HEDIS/STARS data.Key ResponsibilitiesDevelop and implement comprehensive risk...
-
Oakland, California, United States Altais, Inc. Full timeAbout Our CompanyAt Altais, Inc., we're a mission-driven organization that's revolutionizing the healthcare system for physicians, patients, and the clinical community. Our team is passionate about enabling better healthcare experiences and building breakthrough clinical support tools, technology, and services.About Your TeamWe're a high-performing,...
-
Oakland, California, United States Kaiser Permanente Full timePosition Overview: The Director of Compliance in Risk Adjustment is responsible for overseeing and enhancing a robust compliance framework that adheres to best practices in risk adjustment. This role is pivotal in ensuring adherence to federal, state, and local regulations while fostering ethical conduct within the organization. The Director will guide the...
-
Senior Director of Compliance in Risk Adjustment
3 weeks ago
Oakland, California, United States Kaiser Permanente Full timePosition Overview: The Director of Compliance for Risk Adjustment is responsible for the strategic oversight and enhancement of a robust compliance program focused on risk adjustment practices. This role is essential in ensuring adherence to federal, state, and local regulations while fostering a culture of ethical conduct and compliance within the...
-
Head of Risk Adjustment Compliance Strategy
4 weeks ago
Oakland, California, United States Kaiser Permanente Full timePosition Overview: The Director of Compliance for Risk Adjustment is responsible for the strategic oversight and enhancement of a robust compliance program aimed at ensuring adherence to legal standards and ethical practices within the realm of risk adjustment. This role is pivotal in steering the compliance initiatives across various risk adjustment...
-
Oakland, United States Hueman Risk Adjustment Full timeJob DescriptionJob DescriptionHueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Oakland, ME. This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying a...
-
Nurse Practitioner NP, Part-Time, HRA
2 months ago
Oakland, United States Hueman Risk Adjustment Full timeJob DescriptionJob DescriptionHueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Oakland, CA. This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying a schedule designed with...
-
Nurse Practitioner NP, Part-Time, HRA
3 months ago
Oakland, United States Hueman Risk Adjustment Full timeJob DescriptionJob DescriptionHueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Oakland, MD. This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying a schedule designed with...
-
Risk Management Analyst
4 months ago
Oakland, United States Talantage, LLC Full timeJob DescriptionJob DescriptionJob Title: Risk Management AnalystJob Summary:Under the direction of the Risk Manager or his/her designee, provides administrative support and assistance to the Risk Manager in the areas of claims management, safety and general insurance programs; performs related work as assigned.Job Duties:• Receives, evaluates and processes...
-
Oakland, California, United States Kaiser Permanente Full timePosition Overview: The Director of Compliance in Risk Adjustment is responsible for the strategic oversight and enhancement of a robust risk adjustment compliance framework aimed at preventing legal infractions and promoting ethical conduct in alignment with applicable regulations. This role is pivotal in guiding the risk adjustment compliance operations...
-
Clinical Documentation Auditor
2 weeks ago
Oakland, California, United States Medical Hill Healthcare Center Full timeJob Summary:Medical Hill Healthcare Center is seeking an experienced Medical Records Specialist to facilitate audits of clinical documentation and ensure compliance with internal policy, county, and state requirements.Key Responsibilities:Perform routine and assigned audits by the agency's internal audit planPrepare reports and audit findingsCollaborate with...
-
Senior Manager, Risk Management
4 weeks ago
OAKLAND, United States PG&E Corporation Full timeRequisition ID # 159845 Job Category: Compliance / Risk / Quality Assurance Job Level: Senior ManagerBusiness Unit: Gen Counsel, Ethics, Risk & ComplianceWork Type: HybridJob Location: Oakland Department OverviewThe men and women of General Counsel & Ethics, Risk and Compliance ensure the delivery of safe and reliable service to our customers. This...
-
Senior Manager, Risk Management
3 weeks ago
OAKLAND, United States PG&E Corporation Full timeRequisition ID # 159845 Job Category: Compliance / Risk / Quality Assurance Job Level: Senior ManagerBusiness Unit: Gen Counsel, Ethics, Risk & ComplianceWork Type: HybridJob Location: Oakland Department OverviewThe men and women of General Counsel & Ethics, Risk and Compliance ensure the delivery of safe and reliable service to our customers. This...
-
Senior Manager, Risk Management
7 days ago
OAKLAND, United States PG&E Corporation Full timeRequisition ID # 159845 Job Category: Compliance / Risk / Quality Assurance Job Level: Senior ManagerBusiness Unit: Gen Counsel, Ethics, Risk & ComplianceWork Type: HybridJob Location: Oakland Department OverviewThe men and women of General Counsel & Ethics, Risk and Compliance ensure the delivery of safe and reliable service to our customers. This...
-
Lead Risk Analyst
4 weeks ago
Oakland, California, United States Kaiser Permanente Full timePosition Overview:The Lead Risk Analyst is responsible for assessing both standard and complex data to gain insights into premiums, claims, exposures, and overall population dynamics. This role involves independently identifying and escalating actionable insights and irregularities while researching viable solutions. The Lead Risk Analyst plays a crucial...
-
Care Manager RN
2 weeks ago
Oakland, California, United States Altais Full timeAbout AltaisAltais is a leading healthcare organization dedicated to revolutionizing the healthcare system for physicians, patients, and the clinical community. Our mission is to enable better healthcare experiences and improve patient outcomes through innovative clinical support tools, technology, and services.About the RoleWe are seeking a highly skilled...
-
Risk Management Strategist
7 days ago
Oakland, California, United States PG&E Corporation Full timeJob SummaryWe are seeking a highly skilled and experienced Principal Risk Analyst to join our team at PG&E Corporation. As a key member of our Enterprise Service Delivery (ESD) Business Operations team, you will be responsible for providing strategic counsel and program governance to drive integrated, cross-organizational solutions.Key...
-
Care Manager, LVN
2 weeks ago
Oakland, California, United States Altais, Inc. Full timeAbout Our CompanyAt Altais, Inc., we're seeking bold and curious clinicians and innovators who share our passion for enabling better healthcare experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. Our organization is dedicated to building breakthrough clinical support tools,...
Manager, Risk Adjustment Clinical Quality Documentation
4 months ago
Job Description
Job Title:
Manager , Risk Adjustment, Clinical Quality Documentation
FLSA Status:
Job Code :
Pay Grade:
Core Bay Area 13
Date/Revision Date:
2/3/2022
Track:
Family:
Clinical Performance
Level:
Sub-Family:
CQDP
Job Summary & Responsibilities
Job Summary
The Risk Adjustment Manager provides leadership and direct support for Brown & Tolands key risk programs across all lines of business. This position will work directly with leaders to deploy a comprehensive coding, documentation, chart chase, and annual health assessment programs to ensure compliant and sustainable growth. This also includes managing and developing direct reports, program Implementation, work plan development, vendor management, and data- driven performance improvement.
Essential Functions
* Stay informed of all risk related program requirements from CMS and develop implementation strategies to CMS requirements.
* Oversee implementation of risk adjustment analytics platform and related technological solutions, including integrated POC tools within EPIC
* Develop best practices related to data aggregation as it relates to coding, claims, encounter data, and lab data
* Lead cross-functional workgroups to design and monitor risk adjustment programs including retrospective and prospective chart chases, provider education programs, Annual Health Assessment programs, and coding.
* Manage relationships with 3rd party vendors and health plans and other organizations who are providing services, products, and solutions to support risk and quality related programs.
* Meet with direct reports on a weekly basis for 1-1 meetings
* Review contracts collaborate with Legal and Compliance
* Review Budgets and approve Invoices as per VP of Clinical Performance
Key Skills
* Ability to work independently and problem solve
* Ability to clearly communicate, both verbally and in written format
* Proficient in Microsoft Excel and Word
* Meeting facilitation
* Epic EMR experience preferred
* Proficient in Power Point
* Excellent organizational skills
Management
* This position supervises staff : Specialists, RNs, Coders, NPs
Qualifications
Education
* Bachelors degree or equivalent experience required, MBA or other advanced healthcare degree preferred
* CRC, CPC, or other relevant certification through AAPC preferred
Experience
* Five plus (5+) years healthcare administration experience preferred; other relevant experience will be considered; previous risk adjustment and/or Medicare STARS experience a strong plus.
Role Competencies
Competency
Level
Description
Core Competencies
Collaboration
Individual Contributor
* Works cooperatively with Team members across the organization to achieve shared objectives
* Partners with Team Members to get work done
* Gains trust and support across the organization
Excellence
Individual Contributor
* Regularly meets targets and metrics
* Pushes Team Members to set high standards and performance targets and exceed them
* Sets solid targets that drive results
Compassion
Individual Contributor
* Contributes to a work climate where differences are valued and supported
* Applies Team Members diverse experiences, styles, backgrounds and perspectives
* Treats Team Members with kindness
Integrity
Individual Contributor
* Acts fairly despite conflicting demands
* Behaves in a way that is consistent with what he/she says around honesty, ethics, and integrity; leads by example
* Presents truthful information even if not always favorable
Innovation
Individual Contributor
* Introduces new ways of looking at problems
* Can take a creative idea and put it into practice
* Encourages diverse thinking to promote and nurture innovation
Work Dimensions
Level Factor
Requirement (direct from leveling guide)
Work Dimension
Scope & Impact
--
Knowledge & Skill
Developing professional expertise
Complexity
Works on problems of moderate scope, Exercises judgment within defined procedures
Interaction
--
Supervision
Normally receives general instructions on routine work
Experience
Typically requires Bachelors degre e , 5 + years professional experience
* Activity: Sit: Continuously (more than 2/3 of the work shift)
* Activity: Stand: Occasionally (up to 1/3 of the work shift)
* Activity: Walk: Occasionally (up to 1/3 of the work shift)
* Motion: Bend/Twist: Up to 1/3 of time
* Motion: Carry/Lift: Up to 1/3 of time
* Motion: Reach: Up to 1/3 of time
* Motion: Squat: Up to 1/3 of time
* Use of Hands (Left/Right): General Motor Function
* Use of Hands (Left/Right): Precise Motor Function (Or Fine Manipulation)
* Use of Hands: Repetitive Motion: 1/3 or more of time
* Weight Lifted/Force Exerted: Up to 10 lbs: Up to 1/3 of time
* Work Environment: Special visual or auditory requirements including working with a computer terminal.
