Freelance Remote Risk Adjustment Coder Jobs in Charleston, SC

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) Float to lead its in-home multi-specialty polychronic care model across an assigned region. This role involves overseeing daily clinical and business operations, contributing to clinical strategies, and ensuring improved patient health outcomes. The MPE Float will collaborate with a robust clinical team to deliver exceptional care through disease detection and evidence-based clinical pathways.

Practice Info

• Lead an in-home multi-specialty polychronic care model in an assigned region to support all markets.
• Each market is comprised of 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 to deliver in-home specialty care.
• Deploy a proven risk-based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms.
• Focus on improving patient experience, population health outcomes, provider satisfaction, and lowering costs, aligning with the Quadruple AIM.
• Oversee the daily clinical and business operations through delivery of direct patient care, care management services, social worker support, and pharmacy services within the market.

Responsibilities

• Know, understand, and deliver on Monogram Health's proprietary evidenced-based clinical pathways, ensuring adherence to established clinical guidelines and the Monogram Model of Care.
• Review and approve APP, RN, SW, and PharmD plans of care, and appropriate and timely patient documentation within Salesforce and Athena clinical activities, interventions, and tasks.
• Overall accountability for reducing total cost of care and Medical Loss Ratio, and for clinical outcomes including clinical interventions closure, inpatient/outpatient utilization, pharmacological prescribing and therapy management, multi-specialty platform, and HEDIS/Gap Closure.
• Actively lead daily high-risk and concurrent review rounds, and direct supervision of front-line clinical and operations team members.
• Provide direct and indirect patient care (including diagnosis and treatment of disease), engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
• Conduct Peer to Peers with community, facility, and health plan partners, and 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, completing quality post-hospital discharge visits, and improving the quality of visits.
• Participate in Monogram On-Call activities, with needs varying and a minimum of 7 days on call once per 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
• 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

• 7 days on call minimum once/quarter

Requirements

• Must be willing and able to obtain hospital privileges at required facilities.
• This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel.
• 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.
• BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.