Assistant Director- Quality and Risk Adjustment

AgeWell New York is seeking a&nbsp;<strong>Full Time Assistant Director of Quality and Risk Adjustment&nbsp;</strong>skilled in Quality Programs, grievance and appeals procedures, and risk adjustment,&nbsp;to join its team of professionals at our offices in Lake Success, NY.&nbsp;

Lake Success, NY

AgeWell New York

<h1>Join the AgeWell New York Team</h1> <p>We offer competitive salaries, excellent benefit packages and the opportunity to work and exchange ideas with leaders in their fields of specialization. We work in a friendly, collaborative environment with exciting career-ladder opportunities.</p>

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Assistant Director

Competitive Salary and Benefits

Overview: The Assistant Director of Quality and Risk Adjustment is chartered with developing and implementing new Quality Programs that will elevate and improve Quality awareness throughout the organization. It provides leadership emphasizing process improvement, implementation and measurement. &nbsp;In addition, this position requires extensive knowledge of plan's policies and procedures, grievance &amp; appeals terminology, risk adjustment, and regulatory guidelines for all lines of business.<br /><br />This position offers competitive compensation, health insurance, dental insurance, life insurance, 401(k) with company match, paid time off, free parking and more. &nbsp;Qualified candidates are encouraged to apply immediately. &nbsp;AgeWell New York is a growing managed care plan, with career development and advancement opportunities.
Responsibilities: <ul> <li>Oversight of the day-to-day operations of the Quality Improvement, Appeals &amp; Grievances, Population Health, and Wellness Coach teams</li> <li>Assists providing ongoing evaluation of systems, programs, and strategies to support the improvement of quality and utilization management through promoting and supporting innovation</li> <li>Develops, recommends, and implements effective and efficient standards, protocols and processes, reports and benchmarks that support and further enhance the quality of healthcare services</li> <li>Responsible for maintaining compliance with federal and state regulations as well as internal standards; facilitating assigned quality committees; and collecting, analyzing, and reporting data.</li> <li>Works collaboratively with key senior staff toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution</li> <li>Develop and maintain an expert level knowledge of Medicare and risk-based reimbursement methodologies.</li> <li>Assist in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects</li> <li>Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives</li> <li>Leads identification and implementation of quality improvement and population health programs that improve performanc</li> <li>Works with Information Systems Department to ensure that data systems and programs adequately support clinical quality improvement activities, including Risk Adjustment tracking system and databases</li> <li>Leads analysis of statistical information and presentation of trends in complex patient populations and identify quality improvement opportunities, especially related to contractual clinical quality standards and risk adjustment opportunities</li> <li>Compiles statistical data and writes narrative reports summarizing quality assurance &amp; risk adjustment findings</li> <li>Propose opportunities to maximize reimbursement based on CMS- HCC Model and Methodology</li> <li>Assist in developing, validating and implementing data mining strategies for members covered under risk-based models of Medicare Advantage and FIDA</li> <li>Develop enterprise-wide data collection methodology and an effective HCC/RAF coding program</li> </ul>
Requirements: <ul> <li>Master's Degree in Healthcare, Nursing, Business or related field</li> <li>The right candidate will understand quality improvement models, processes and tools, have current knowledge of regulatory trends and understanding of the National Committee for Quality Assurance (NCQA) structure and standards, Health-plan Employer Data and Information Set (HEDIS) requirements, and how to use Electronic Medical Records and computerized statistical methods</li> <li>5 years of progressive health care experience, 5 years of management/leadership experience or equivalent combination of education and experience</li> <li>Strong communication and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse stakeholders</li> <li>Demonstration of conflict resolution and mediation skills</li> <li>Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to manage compliant operation</li> <li>Working knowledge of Microsoft Office: Word, Excel, Access, PowerPoint, etc.</li> </ul>