Job Description

Risk Adjustment/Quality Program Manager - Specialty Programs

U.S. Medical Management (USMM) is an affiliate of a leading Fortune 100 company. A national organization built on a continuum of care with premier healthcare providers, clinicians and patient focused individuals working together. Our Mission Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services Visiting Physicians Association, Pinnacle Senior Care, Grace Hospice, Comfort Hospice, Home DME & our In Home Health Assessments (IHA).

Our Values of Integrity, Respect, Teamwork & Excellence are leading us to a better tomorrow for patient care. Our Purposes Centered on We are Unified in our Work through our Continuum of Services We can Find Comfort that We are Making a Difference for our Patients & We make a Broader Positive Impact on Society, allows USMM to be poised for a phenomenal future.

We are seeking candidates who desire the experience of delivering quality & compassionate healthcare within proven care models with patients at the forefront of everything we do.

Benefits We Have to Offer:

* Health, Dental, Vision, Disability & Life Insurance
* 401K Retirement Plan
* Paid Holidays
* PTO
* Flexible Spending Account
* Tuition Reimbursement (coming 2021)

Position Description

The Risk Adjustment/Quality Program Manager Specialty Programs is responsible for the day-to-day program support for all risk adjustment and quality Specialty Programs. These activities include, (not inclusively) program implementations, coordination of operational cross-departmental initiatives within USMM and Centene, research/presentations to support current and growth businesses tied to Specialty Programs. Act as the interface between USMM business units, IT technical staff and corporate partners while providing operational support to all specialty programs.

Essential Duties and Responsibilities

* Daily program management throughout the program life cycle and end-to-end processes, including program governance, resources, tasks, deadlines, etc.
* Manages the complete implementation and ongoing monitoring of IHA initiatives, such as:
* Community Health Services
* Telehealth
* Mobile Clinics
* Email/Text Campaigns
* Other Specialty Program Initiatives
* Manages program requirements confirming vendors comply with Centene approved file formats and reconcile receipt of timely IHA vendor file submissions, including (but not limited too):
* Disposition Reports
* Lab Files
* Hedis Non-Lab Files
* Charge Files
* Urgent Case Management Referrals
* Non-Urgent Case Management Referrals
* PDF Assessment Summaries
* PDF Assessment crosswalk/inventory
* Capacity
* Forecast
* Other Specialty Program reports
* Manages, reports, responds to ongoing vendor monitoring, including:
* Call Monitoring Audits
* Quarterly Coding Audits
* Complete 5% internally
* Completed by Centene
* Vendor SLAs
* Manages validation and reconciliation process for all vendor invoices
* Manages the successful process for automatic file transfers between Centene, USMM and IHA Vendors for all IHA files. Notifying the Specialty Program Business Analyst and/or MCO Specialist to resolve any issues.
* Tracks all Centene Outreach, Gap, Diagnosis, and Supplemental Data files, ensuring information is accurate and assigned correctly.
* Responds to Ad Hoc requests from Health Plans and Centene concerning IHA or Specialty Programs.
* Coordinates all vendor weekly meetings, capturing minutes, action items and outcomes.
* Be the interface between USMM business units, IT technical staff and Centene corporate partners
* Other duties as assigned

REQUIRED Knowledge, Skills and Experience

* Bachelors Degree
* Demonstrated written and verbal communications skills
* Advanced operational knowledge of Microsoft Office and SharePoint

Preferred Knowledge, Skills and Experience

* Previous Risk Adjustment experience