Market Director Population Health Quality and Risk

Common Spirit•Little Rock, AR

53d•Remote

About The Position

Will have oversight for Arkansas, Tennessee/Georgia, Kentucky and Ohio markets. Work-mode is flexible/remote; preferably reside either in the EST or in CST zones, and up to 25-50% professional travel may be involved. Supports quality, clinical practice, safety, risk coding, compliance, patient experience and Health Information Management functions within the Value Hub (Clinically Integrated Networks/CINs). Facilitates quality and patient experience performance across the SE Region Value Hub (VH) of CommonSpirit Health. Demonstrates productive and organized leadership in the development and implementation of performance improvement plans and programs necessary to meet strategic objectives. Conducts provider and quality incentive programs in the value hub. Manages a team of managers/personnel with varying critical organizational roles. Serves as market liaison, interfacing with internal clinical leaders and external payer partners for all things quality and risk for the value hub. Through Risk Management/Auditor Manager, implements a risk adjustment coding department in appropriate Arkansas and Kentucky CIN. Educate providers to improve documentation and coding practices, for accurate claims submissions and accurate reimbursement. Continue to work closely with managers and providers to build relationships, establish trust and open communication related to documentation best-practices, accurate documentation and coding, and claims submissions Participate/assist in pilot programs for concurrent and retrospective review processes. Assist in the creation of workflows and guidelines for these new processes. Support the Risk Auditor Manager of closely working with the HCC Risk auditors to establish, and update daily workflows and audit processes. Ensure that auditors stay current on guidelines and best practices and maintain the highest level of ethics in their chart reviews and provider interactions. Use the weekly auditor's roundtable to challenge each other and expand our knowledge on the most complicated areas of documentation and coding.

Requirements

Bachelors Degree in Nursing required
Current, unencumbered RN license in primary state of residence with ability to apply for multistate licensure (AR, KY, TN, GA, OH) per the NLC
5 years leadership experience
Extensive CIN/Population Health Management experience required
Must have experience with risk adjustment coding and value based reimbursement models of payment
Knowledge of CMS, NCQA, ambulatory care, quality, and population health

Responsibilities

Oversight for Arkansas, Tennessee/Georgia, Kentucky and Ohio markets.
Supports quality, clinical practice, safety, risk coding, compliance, patient experience and Health Information Management functions within the Value Hub (Clinically Integrated Networks/CINs).
Facilitates quality and patient experience performance across the SE Region Value Hub (VH) of CommonSpirit Health.
Demonstrates productive and organized leadership in the development and implementation of performance improvement plans and programs necessary to meet strategic objectives.
Conducts provider and quality incentive programs in the value hub.
Manages a team of managers/personnel with varying critical organizational roles.
Serves as market liaison, interfacing with internal clinical leaders and external payer partners for all things quality and risk for the value hub.
Implements a risk adjustment coding department in appropriate Arkansas and Kentucky CIN.
Educate providers to improve documentation and coding practices, for accurate claims submissions and accurate reimbursement.
Participate/assist in pilot programs for concurrent and retrospective review processes.
Support the Risk Auditor Manager of closely working with the HCC Risk auditors to establish, and update daily workflows and audit processes.