Senior Director, Medicare Risk Adjustment Leadership

4 weeks ago

Dinan, Bretagne, United States Somatus Full time

Overview:

Somatus, a leading value-based kidney care company, is seeking a seasoned professional to lead its Medicare Risk Adjustment (MRA) program. As the Senior Director, Medicare Risk Adjustment, you will be responsible for executing the organization's MRA strategy, ensuring compliance with governing bodies' regulations, and driving program improvements.


Responsibilities:

• Develop and implement MRA strategies to optimize clinical benefit, financial accuracy, and program compliance.

• Partner with leadership to facilitate decision-making and provide strategic recommendations for program improvements.

• Lead the risk adjustment operational programs and strategy, focusing on monitoring, oversight, and compliance for risk score accuracy.

• Collaborate with cross-functional teams and external vendors to execute MRA strategy and ensure compliance with CMS rules and regulations.

• Develop program goals and key performance indicators (KPIs) to ensure accountability across the organization.

• Manage processes needed to conduct at-home wellness visits and ensure accurate coding for documentation and auditing.

• Oversee and manage the compliance and performance of vendors or third-party administrators performing risk adjustment activities.


Requirements:

• Bachelor's degree in business, healthcare administration, or related field.

• Minimum 10 years of experience in healthcare, managed care, health insurance, or strategic consulting, with a focus on Medicare Advantage risk adjustment functions.

• Proven experience leading and formulating strategies, leveraging knowledge of the external markets and regulatory environment to create value for the organization.

• Strong business acumen, excellent strategic thinking, and effective problem-solving skills.

• Excellent verbal and written communications skills, with the ability to communicate, present, and influence at all levels of an organization.


What We Offer:

Somatus is committed to providing a comprehensive benefits package, including:

• Subsidized, personal healthcare coverage (medical, dental, vision)

• Flexible Paid Time Off (PTO)

• Professional Development, CEU, and Tuition Reimbursement

• Curated Wellness Benefits supporting teammates' physical and mental well-being

• Community engagement opportunities

• And more


Why Join Somatus:

Somatus is a dynamic and innovative company that is revolutionizing the kidney care industry. As a member of our team, you will have the opportunity to work with a talented and passionate group of professionals who are dedicated to making a difference in the lives of patients with chronic kidney disease. We offer a collaborative and inclusive work environment that promotes growth, innovation, and excellence.


Equal Employment Opportunity:

Somatus is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and respectful work environment that values diversity, equity, and inclusion.

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