Freelance Remote Risk Adjustment Coder Jobs in Georgia

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) to lead its in-home multi-specialty polychronic care model within an assigned market. This role involves improving patient well-being, quality of life, and health outcomes by leveraging proprietary AI algorithms and a risk-based model. The MPE will focus on enhancing patient experience, population health outcomes, provider satisfaction, and cost reduction, ultimately delivering exceptional outcomes through disease detection and evidence-based clinical pathways.

Practice Info

• Lead an in-home multi-specialty polychronic care model in an assigned market.
• Each market comprises 5-10 practices led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists (PharmD).
• Collaborate with Monogram Health's Multi-Specialty Platform to leverage employed specialists for in-home specialty care.
• Deploy a proven risk-based model utilizing proprietary next-generation AI algorithms to predict appropriate care levels.
• Oversee daily clinical and business operations through direct patient care, care management services, social worker support, and pharmacy services within the market.
• Collaborate with community physicians, facilities, and partners in peer-to-peer and direct patient care decision-making.

Responsibilities

• Know, understand, and deliver on Monogram Health's proprietary evidenced-based clinical pathways and ensure adherence to established clinical guidelines and the Monogram Model of Care.
• Review and approve APP, RN, SW, and PharmD plans of care, and review, approve, and co-sign APP encounters.
• Maintain overall accountability for reducing total cost of care and Medical Loss Ratio, and for clinical outcomes including clinical intervention closure, inpatient/outpatient utilization, pharmacological prescribing, and therapy management.
• Actively lead daily high-risk and concurrent review rounds, and provide direct supervision of front-line clinical and operations team members.
• Provide direct and indirect patient care, including diagnosis and treatment of disease, and engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
• Order labs, referrals, and complete actions to drive patient outcomes, close care gaps, and clinical intervention closure.
• Provide clinical guidance and direction to Market teams to drive Population Health Management activities, including identifying and intervening on High-Risk Patients, formulating strategies to reduce admissions/readmissions, and improving the quality of visits.
• Participate in Monogram On-Call activities (7 days on call minimum once/quarter) and provide coverage for other MPEs during PTO or vacancy, as needed.

Compensation

• Competitive compensation
• 401k with employer match

Benefits

• Medical, dental, and vision insurance
• Employee assistance program
• Employer-paid and voluntary life insurance
• Disability insurance
• Health and flexible spending accounts
• Financial wellness resources
• Paid holidays
• Flexible vacation time/PSSL
• Paid parental leave
• Work life assistance resources
• Physical wellness perks
• Mental health support
• Employee referral program
• BenefitHub for employee discounts

Shift & Schedule

• This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel.
• Participate in Monogram On-Call activities Needs will vary; 7 days on call minimum once/quarter.

Requirements

• Must be willing and able to obtain hospital privileges at required facilities.
• Demonstrated experience applying evidence-based clinical criteria.
• Experience in renal care and geriatrics.
• Strong management and communication skills.
• Active, unrestricted state medical license required in each state within the market.
• Experience with high need Medicare Advantage and managed Medicaid populations.
• Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
• Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
• Willingness to become licensed in multiple states.
• MD or DO degree from an accredited medical school, and BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.