Full time Risk Adjustment Medical Director – Roma Location, Albuquerque New Mexico

Overview 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 Functions:

• 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 studies.
• 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 requirements.
• Responsible for onboarding, ongoing, and targeted education of all physicians on coding and documentation for Medicare risk adjustment.
• Accountable for the overall improvement and performance in risk adjustment metrics.
• 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 documentation.
• Meet with market President/CMO/Leadership for department metric updates.
• 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 creation.
• Other duties as assigned

Education:

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 the coding/billing/documentation
• Ability to engage contracted providers through indirect influence

Knowledge, Skills, Abilities:

• Thorough understanding of medical group business models and clinical processes.
• 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, IBNR, MLR).
• Helping set agendas/strategies and leading multifaceted teams of Physician Business Managers, Risk Adjustment dyads, and Quality partners.
• 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 PowerPoint.

Licensure: Required:

• 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 practice.
• Current BLS Certification

Careers 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.