Risk Adjustment Specialist

Overview:

Responsible for performing routine, up to moderately complex tasks necessary to support the planning and coordination of market initiatives and operational programs related to Medicare Risk Adjustment.

ESSENTIAL FUNCTIONS:

• Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
• Assists Program Managers in analytics, patient engagement and outreach, documentation integrity, clinician education and tools, and audits.
• Create reporting dashboards summarizing and trending performance by Risk Adjustment vendors.
• Document and update changes to workflow, training plans, and policies and procedures.
• Manage the day to day operations of at least one vendor program and/or program initiative.
• Develop training materials (e.g., job aids, presentations, etc.).
• Independently train stakeholders on processes and initiatives.
• Lead calls with stakeholders to identify areas for improvement.
• Supports YEA activities to facilitate comprehensive health assessments.
• Analyzes patient and clinician data to monitor performance, validate outcomes, and identify improvement opportunities.
• Responsible for QA of vendor deliverables and program initiatives.
• Monitor clinical workflow efficiency within sites to make recommendations to provider and the care team regarding process improvement opportunities for closing care gaps; and methods for reaching patient care related goals and metrics.
• Contribute to the design and development of educational materials.
• Supports performance improvement duties for the department.
• Attends internal team meetings and calls to ensure alignment around program objectives, deliverables, and timelines.
• Performs additional responsibilities as assigned.

EDUCATION:

• Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college. 

EXPERIENCE:

Minimum

• Over 3 years.

Preferred

• Experience working with health plans or large physician group.
• Knowledge of Medicare Advantage and population health activities.

Knowledge, Skills, and Abilities:

• Extensive experience with Microsoft applications (Access, Excel, Word, Project).
• Excellent customer service skills.
• Excellent verbal and written communication skills.
• Ability to work in an environment with fluctuating workloads.
• Ability to prioritize workload to meet deadlines and needs of user community.
• Strong analytical and problem solving skills.
• Demonstrated success working in dynamic, fast-paced environment and meeting tight deadlines.

What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)

Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.