Job Description:
The Risk Adjustment Strategic Partner works as a liaison between the provider community and Select Health. This is a niche market that requires a specialized skill set to lead and build relationships with provider organizations, clinic leaders, and healthcare providers. This role will coordinate workstreams that include risk adjustment, HEDIS and STAR gap closure, and healthcare utilization. Travel will be required for in-person meetings with provider organizations.
The Risk Adjustment Strategic Partner will ensure providers understand multiple data points relevant to population health, navigate data tools to monitor and analyze health data to identify trends, and develop strategies to address gaps in care, provide solutions for actionable clinic and provider opportunities, and spearheads the development of tailored programs that cultivate value-based relationships in healthcare. Collaborating closely with leadership, this position will craft implementation plans and provide insights on program effectiveness. The role extends to advising executives on segment-specific strategies, demonstrating independent judgment and decision-making prowess. Operating with minimal supervision to analyze multifaceted issues, this position will identify optimal courses of action and commit to problem-solving.
This is a hybrid position- mostly remote, but minimal travel to some local clinics is required quarterly .
Essential Functions
Accountable for working with provider groups to achieve annual goals, evaluate progress to goal, identify/analyze emerging business needs, and conduct effective provider outreach and engagement for performance improvement.
Develops strategies to address gaps in care and provides solutions for actionable clinic and provider opportunities. Monitors and analyzes the effectiveness of programs, processes, infrastructure, and makes changes to improve results.
Designs and implements reporting across the risk adjustment organization and with external partners (e.g., Kidney Team, Group Medicare).
Supports HQRI strategic engagements, representing risk adjustment across new member initiatives and PPO strategies.
Fosters relationships with providers and clinical leadership, internally and externally.
Manages high-priority initiatives effectively, demonstrating a proactive approach and self-guided leadership.
Works individually and as part of a team to articulate and coach provider partners in the complexities of value-based contracts, quality measures, risk adjustment strategies and aid provider groups through the effective use of data reports.
Leads operational strategies to meet the objectives of Select Health and collaborates with health plan’s partners and leads and facilitates implementation of services in collaboration with Select Health team members and partnerships.
Ensures each clinic has appropriate interoperability with Select Health through data transfer and EMR accessibility and ensures efficient and effective use of resources.
Coordinates resolution of any issues or concerns that may arise between the clinic organization and Select Health.
Collaborates with internal stakeholders to identify and implement risk adjustment initiatives that align with the organization's goals and objectives.
Ensures compliance with regulatory requirements and industry best practices related to population health management.
Manages vendor relationships that support risk adjustment activities.
Is accountable to Select Health leadership in reporting monthly KPI’s for specific groups, regions, lines of business and states
Skills
Risk Adjustment
Relationship Building
Performance Improvements
Management Reporting
Quality Measurements
Data Interpretations
Analytical Thinking
Written Communication
HEDIS
Accountability
Data Reporting
Presentations
Required Qualifications
Proficient at risk adjustment strategy for Medicare and ACA lines of business, including financial impact, RAF score calculations, and return of investment…