JOB SUMMARY:
The Risk Adjustment Performance Manager will be responsible for day to day operational execution of Risk Adjustment Programs in accordance with state and federal regulations. The RA Performance Manager will review operational dashboards, reporting/analytics, and work with both internal & external stakeholders to foster successful outcomes. This position will be expected to help create & monitor KPI Reporting Monthly, articulate complex issues, & problem solve when results are not as expected. The RA Performance Manager will also support current & future vendor oversight & outcomes around Risk Adjustment. This position will initially support ACA, MA, & Medicaid Risk Adjustment for plans based in Massachusetts & New Hampshire. Success will require a high degree of Risk Adjustment exposure, the ability to translate data into action, & a collaborative approach to solve complex situations with internal & external (providers) stakeholders. This position will be telework with frequent provider office visits & Zoom conferencing
KEY FUNCTIONS/RESPONSIBILITIES:
Provider site engagement and partnerships: Partner with provider account teams to communicate risk adjustment execution strategies and initiatives to provider groups; partner with provider groups to implement risk adjustment initiatives.
Accountable for ensuring ongoing key performance indicators are met for the company's risk adjustment program(s), including reporting KPI results on a regular cadence & speaking to outlier results. Contributes to &/or maintains risk adjustment performance management and reporting dashboard
Partner with Risk Adjustment Leadership, Clinical, and Financial Analytics teams to define opportunities and areas of focus to optimize risk adjustment performance across all products.
Partner with vendors & Risk Coding Team to optimize education & training opportunities, driven by data
Internal stakeholder management: Ensures open communication and collaboration across all relevant internal departments/positions that intersect with risk adjustment team (Quality, Provider Relations, Product teams, etc.)
External stakeholder management: Ensures open communication and collaboration across all relevant partners that intersect with risk adjustment team (Provider, Vendor, etc.)
Handle other related duties as required or assigned
Assist with development and execution of Standard Operational Procedures, workflows, and process documentation policies for risk adjustment programs
EXPERIENCE REQUIRED:
EXPERIENCE PREFERRED/DESIRABLE:
COMPETENCIES, SKILLS, AND ATTRIBUTES:
Required Skills Required Experience
• Administer Metro's Emergency Management Program (including Preparedness, Mitigation, Response, & Recovery) and associated planning process and ensure that required elements are included in Metro's SOP’s, contracts and programs. • Plan, develop and communicate -- through a variety informational products and media -- with Metro's managers, employees and patrons so that they are prepared to respond to a different emergency situations • Communicate and ensure compliance with all applicable Federal, State and local regulations that relate to transit emergency preparedness, including FTA regulations & best practices, TSA requirements, the National Recovery Plan, the National Incident Management System, and State Safety Oversight • Responsible for the implementation and oversight of emergency preparedness training for employees, supervisors and management. Prepare learning objectives for training programs and establish outcomes for drills & exercises • Develop grant application justifications for DHS & FTA grants related to emergency planning, training, simulation and administer those grants that are awarded • Design, plan, conduct & supervise emergency exercise programs including orientation, tabletops, functional & walk-through drills, and full-scale exercises • Develop, implement, and monitor a comprehensive emergency preparedness/business continuity plan. • Act as a liaison with local, state & Federal emergency response agencies, in coordination with Metro's Executive Emergency Management Committee • Chair Metro's Fire Life Safety & Security committees and review policies and procedures of the more than 150 first response agencies that might respond to a Metro emergency • Develop, implement, and oversee Metro's Emergency Response Familiarization programs to ensure that fire, EMS, and local law enforcement are prepared to respond to a transit emergency • Perform assigned safety tasks as requested • Ability to work on-call for periods of seven consecutive days (24 hours per day) on a rotating basis. Must maintain a valid driver’s license and have the ability to obtain a CDL. Response and investigation of accidents, safety hazards, and injuries