Senior Director Risk Adjustment Department

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

The Vice President (VP) of Risk Adjustment, reporting to the Senior VP, serves as a key leader responsible for driving success, improvement and innovation while implementing activities in support of Enterprise and Risk Adjustment strategic priorities. The VP is responsible for strategic leadership, direction and operational support as well as execution of risk adjustment activities for the WellMed enterprise, activities enterprise activities in all markets in which we conduct business as well as support to care delivery organizations utilizing WellMed's platforms. The VP will provide strategic leadership and oversight of program goals that drive Risk Adjustment Factor (RAF) accuracy, onboarding services as well as overseeing and driving improvement in the submission activities for the centralized services. This leader provides leadership and engagement to ensure the appropriate integration of activities into strategic direction and operations, as well as the mission and values of the company while complying with legal and regulatory requirements.

Primary Responsibilities:

• Provide long-range planning and oversight of DataRAP operations
• Facilitate risk adjustment portion at the Quality and Risk Adjustment (RA) and Contracted Provider Results (CPR) Best Year Yet (BYY) meetings to ensure physician and business leaders understanding and to ensure implementation of strategy at local and regional level.
• Develop strong partnership with regional dyads to execute on enterprise strategy and objectives within their respective markets
• Lead the short and long term planning process and drive prioritization to meet the enterprise financial performance goals
• Work with Regional Leadership to develop and implement best practices and utilization of standard process/tools across WellMed contracted and employed providers
• Ensure implementation of standardized risk adjustment reporting across the enterprise and for those CDOs utilizing DataRAP
• Ensure application of clinical algorithms within attestation process to enhance ability of providers to assess and document the complete health status of members
• Identify operational issues/barriers and provide recommendations to team and market leaders to increase efficiency and maximize results
• Coordinate education for all markets including providers and employees to ensure compliance with corporate risk adjustment processes
• Plan for and implement a structure that meets operational needs through continued growth
• Develops and governs the annual budget for department and implements plans to achieve budgetary goals
• Develop and execute communication to internal and external stakeholders related to clinical documentation strategies and implementation plans

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 8+ years of experience working with provider groups or health plan with population/medical management experience
• 5+ years of experience in progressive management roles
• Proven track record in leading major organizational strategy and leading multi- market teams in implementing strategy and objectives
• Solid and progressive experience of progressive responsibility
• Ability to effectively manage projects, plan, and implement programs and evaluate accomplishments
• Ability to effectively report data, analyze facts and exercise sound judgment when making recommendations to members of the Executive Leadership Team
• Knowledge of staffing, training, coaching and employee discipline practices
• Proficiency with standard Microsoft Office applications
  

Preferred Qualifications:

• Registered Nurse licensed in any US state
• 10+ years of experience working with provider groups or health plan with population/medical management experience
• Operations experience in large, matrix healthcare environment
• Solid knowledge of regulatory requirements and regulations
• Knowledge of federal and state laws relating to managed care and medical management

Physical & Mental Requirements:

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.