Risk Modeling Manager jobs in Olympia, WA

 THIS POSITION REQUIRES WASHINGTON STATE RESIDENCY

Employees must establish a residence in Washington State within 30 days of their first day of employment and must maintain a residence in Washington State during their employment with PSW.  If a position is eligible to telework, work performed while teleworking must be performed in Washington State.

Summary / Objective:

Operationalize provider engagement initiatives to drive performance improvements related to Risk Adjustment, accurate condition documentation, and Medicare Stars. The Risk and Quality Manager is responsible for deploying actionable campaigns to enable provider performance, including analyzing performance data, partnering with the MCC Director of Risk Adjustment to set targets, and communicating improvements.

Essential Functions:

• Engages with provider Network(s) to apply industry best practices related to risk adjustment and coding capture. Identifies barriers and offers tailored solutions based on group cultures and competencies.
• Improves provider organization performance through data analysis, knowledge of best practices, and development and execution of interventions in collaboration with peers and leaders of contracted healthcare delivery systems.
• Serves as a subject matter expert on MA and ACO programs and objectives such as quality, risk adjustment, and other Medicare programs.
• Stays informed and updated on measures, program changes and quality gap closure processes.
• Establishes credibility as a trusted advisor and resource to influence positive change while imparting a great company image and professional demeanor.
• Participates in internal workgroups to support development of effective member and provider network-directed interventions; coordinates interventions with internal stakeholders.
• Monitors Provider progress and creates awareness of course corrections when needed.
• Conducts retrospective chart reviews and provides actionable information to providers to ensure accuracy, compliance and best practice.
• Monitors supplemental data exchange strategy between provider groups and PSW to support the improvement in performance measures for the Stars program.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Assesses and communicates project status, key business risks and vulnerabilities to leadership.
• Recommends and implements appropriate action steps and coordinates with internal teams to follow through to close action plans.
• As a Network Management team member - lead, participate, and contribute to internal committees/workgroups as assigned; acts as a mentor to others within the overall team.
• Creates a sense of urgency within the organization and translates quickly evolving directions into action.
• Adheres to all quality, compliance and regulatory standards

Knowledge/Skills/Abilities:

·         Set a positive example by displaying a pleasant and approachable demeanor and always remaining friendly and courteous.

·         Proactive team player, strong follow through, quick decision-making abilities and ability to problem solve.

·         Interpersonal skills, with the ability to build strong relationships at all levels.

·         Adapts to changing work environment with flexibility and recognizes potential impact with ability to accentuate the positive to maintain/increase staff morale

·         Strong verbal and written communication skills with customers, supervisors and co-workers.

·         Strong organizational, time management and prioritization skills

·         Self-starter.  Ability to set priorities and keep to projected schedules and  excellent computer proficiency (MS Office – Word, Excel, Outlook) including being able to effectively maintain written and computer records in accordance with regulatory agencies.