Manager Hcc Risk Adjustment Jobs in Virginia (NOW HIRING)

Hiring Range: $233,000.00 - $302,000.00

Actual pay depends on specialty, experience, and performance

Riverside Medical Group is currently seeking a Quality and Value Based Performance Medical Director (Physician) to join our team at Riverside Medical Group in Newport News, Virginia

In this role:

The Quality and Value Based Performance Medical Director provide physician leadership for value-based care initiatives across all payers. This role focuses on improving quality, outcomes, utilization, and financial performance through data-driven strategies, collaboration with clinical and operational leaders, and engagement with payer partners.

To perform this job successfully, an individual must be able to perform each essential job function. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions.

Essential Job Functions:

• Lead and support value-based performance initiatives across payer programs, including MSSP and commercial arrangements.
• Monitor and analyze key performance indicators and develop improvement strategies.
• Collaborate with physicians, advanced practice providers, service line leaders, and quality leadership.
• Develop and implement population health dashboards, scorecards, and reporting tools. Standardize clinical workflows and protocols to improve quality and efficiency.
• Standardize clinical workflows and protocols to improve quality and efficiency.
• Review payer performance reports and conduct regular performance reviews with providers.
• Serve as Medical Director of the ACO and participate in ACO management activities
• Participate in payer meetings, Close the Gap initiatives, and rapid-cycle improvement efforts.
• Other duties as assigned.

Requirements for Job:

• Demonstrates leadership behaviors that promote a culture of trusting relationships at all levels within Riverside. Practices inclusion and values diversity. Creates enthusiasm and celebrates successes.
• Aligns initiatives with strategic goals. Recognizes and acts on opportunities that improve and grow the organization. Identifies goals and motivates team to consistently achieve goals. Proactively monitors key performance indicators and makes real time adjustments.
• Demonstrates personal accountability of resources. Meets or exceeds annual revenue budget (if applicable). Demonstrate flexibility to increase service access to customers.
• Responsible for demonstrating the Riverside Care Difference behaviors. Leaders ensure accountability for positive customer experience. Sets and maintains high standards for service. Demonstrates care commitments in all interactions. Anticipates and adapts to customer needs to enhance their experience.
• Holds self and others accountable for delivering the best outcomes possible by communicating quality and safety goals, promoting and complying with evidence-based practices, cross checking, coaching, encouraging safe behaviors and by fostering a culture that is fair and just. Seeks to provide the best quality care/service within the department(s).
• Demonstrates responsibility and engagement by completing leadership requirements on time. Meets department and system deadlines (i.e. deadlines for budget process, evaluation process, etc.). Makes and keeps commitments. Effectively cascades communications to team members in a timely manner. Compliant with communication tracker.

Skills Requirements:

• Knowledge of EPIC workflows supporting value-based performance.
• Competency in HCC risk coding and population stratification.
• Strong communication, collaboration, and change management skills.
• Understanding of medical loss ratios and payer cost structures.

Educational Requirements:

• Doctor of Medicine or Doctor of Osteopathic Medicine
  • Family Medicine Certification (FMC) - American Board of Family Medicine (ABFM)
  • American Board Emergency Medicine - American Board of Emergency Medicine (ABEM)
  • Internal Medicine - American Board of Internal Medicine (ABIM)
  • American Board Emergency Medicine - American Board of Emergency Medicine (ABEM)
  • General Pediatrics - American Board of Pediatrics (ABP)

Certification(s) and License(s):

• Licensed Medical Doctor - State of Virginia
• Board Certified
• Current DEA registration