Director of Quality & Risk Adjustment
San Jose, CA
Lead Quality and Risk Adjustment teams to meet SMART goals. Develop, implement and monitor strategic and quality and HCC programs to meet goals by Line of Business and individual health plans. With Chief Medical Officer, work with Provider office staffs, Providers and Provider Relations to implement programs designed to achieve accurate, timely and comprehensive documentation of care Responsible for all quality operations including administratively managing Committees Work with Steering Committee to roll-out our internet based, easy-to-use PCP dashboard for Quality measurement and HCC reporting (COZEVA). With Compliance, assist with delegation oversight audits, quality investigations, appeals and grievance resolution. Responsible for CAP responses for quality issues. Work with Provider Relations to investigate and resolve provider and other quality issues as arise; trend, track and reporting information.
- Bachelor’s degree required. In addition, background in business analytics and statistics strongly preferred.
- 3-5 years’ experience in managed care quality and/or Medicare Risk Adjustment. Experience with NCQA Quality accreditation, Medi-Cal MCAS, or STARs HEDIS measure tactical programs and reporting preferred.
- 3-5 years direct management experience. (health plan, medical group or primary care clinic setting)
- Strong written and oral communication skills
- Proficient with Microsoft Office (Word, Excel, Outlook) is required.
- Organizational skills sufficient to work on multiple projects simultaneously within established timeframes