Lead Director Quality Management
CVS Pharmacy - New Albany, OH
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Job DescriptionThe Lead Director, Quality Management is a highly visible and local market leadership position. You will be responsible for driving Medicare Risk Adjustment performance a specific market. Fully accountable for MRA strategy, performance, and results within the local market. You will collaborate with Aetna's enterprise Revenue Integrity teams to execute on critical initiatives. Responsible for identifying nuanced local market MRA strategies and executing tactics to maximize results. You will develop processes, workflows, and other materials to document the operational and strategic components of initiatives. The position is remote but you must reside in the state of Ohio or Kentucky.Fundamental Components Conduct data analysis to identify and prioritize provider outreach opportunities for coding education and MRA initiatives. Lead team of coding educators who engage with local providers to evaluate coding and documentation performance and trends; builds strategies for ongoing improvement. Lead cross-functional work groups and partners with local and enterprise colleagues from Aetna's Revenue Integrity, Network, and Clinical teams. Collaborates with Provider Engagement Managers and RN Program Managers to maximize the risk score performance of Aetna's value-based provider partners. Engage with clinical teams and providers and serves as a SME on Medicare Risk Adjustment, coding, and documentation. Ensure successful results in medical record retrieval projects, prospective coding programs, provider education initiatives, and dissemination of coding standard methodologies. Investigates operational issues that impact MRA performance and works with business partners to implement solutions. Inspire change to improve results and organizational efficiency related to MRA. Manage relationships at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization, as well as with providers and external vendors. Review and manipulate data to draw conclusions. Communicate and prepare presentations to and for senior leadership frequently Translate strategy into measurable goals.Required Qualifications 5+ years of experience in Medicare Risk Adjustment Experience leading, developing, and inspiring team of direct reports. Experience leading projects, financial analysis, strategic business planning, and risk management. Experience with enterprise-wide and or cross-functional large-scale initiatives involving a wide degree of complexity. Experience successfully executing change in matrixed organizations. Strong analytical skills,COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsRefer to required qualificationsEducationBachelor's Degree or 9 years of equivalent work experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07