Director of CMD Clinical Operations

Director of CMD Clinical Operations

Requirements

• Demonstrated ability to build and manage teams effectively.
• In depth knowledge of CMS HCC risk adjustment model, and ability to develop the same familiarity with the HSS model.
• Knowledge of documentation and coding guidelines.
• Strong knowledge of the Medicare market, products and competitors.
• Knowledge of clinical standards of care and preventative health measures.
• Excellent organizational capabilities to execute projects/programs and to work effectively as a team player.
• Experience in managed care working with network and provider relations.
• Strong presentation skills and relationship building skills with clinical/non-clinical personnel.
• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels.
• Ability to solve process problems crossing multiple functional areas and business units.
• Good business acumen, especially as it relates to Medicare.

Responsibilities

• Create and curate CRA educational content and develop related curriculum.
• Develop provider onboarding program for new hires.
• Develop virtual and face to face support program for existing provider staff.
• Oversee the team that furnishes these services.
• Provider performance monitoring.
• Partner with other stakeholders to develop meaningful CRA metrics that support enterprise goals and physician compensation design.
• Develop and operationalize programs that ensure underperforming providers are supported in their quest to improve.
• Monitors clinical documentation for accuracy, both proactively and in response to audit requests.
• Implement improvement interventions in partnership with the Dir of Clin Risk Adj Bus Ops, oversee the creation and implementation of improvement initiatives.
• Analytics and Informatics Liaison. Primary liaison with Epic CRA analysts, and in partnership with the Director of Business Ops, serves as liaison to analytics teams.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization’s Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization’s business.

Preferred Qualifications

No preferred qualifications provided.