<p>Manages the risk adjustment initiatives for the organization, including in-home health assessments, embedded NP, medical chart retrieval, HCC risk adjustment data & documentation integrity, and supporting vendor programs. Oversees implementation of programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart. Programs include but are not limited to training and educational activities, Nurse Practitioner and AWV programs, clinical chart review programs, retrospective reviews, encounter submission, data reconciliation, and electronic data submission including supplemental data submissions.</p> <p>To perform this job successfully, an individual must be able to perform the job description satisfactorily. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <ul> <li>Ability to effectively present information within and outside the organization </li><li>Advanced ability to manage and work with minimal supervision or absence of detailed instruction. </li><li>Strong computer skills with proficiency using all Microsoft Office products, and </li></ul> <p>demonstrated ability and willingness to learn new software.</p> <ul> <li>Excellent time management, project management, organizational and communication skills. </li><li>5 years' experience of risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry </li><li>5 years' experience in managerial or supervisory capacity </li><li>Previous experience in value-based revenue and risk adjustment improvement initiatives </li><li>Experienced with health plan guidelines/criteria/ICE/CMS/NCQA/DMHC </li></ul>