Remote Risk Adjustment Auditor Jobs in Tennessee

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 overseeing daily clinical and business operations, providing direct patient care, and collaborating with a multidisciplinary team to improve patient experience, population health outcomes, and provider satisfaction. The MPE will leverage proprietary AI algorithms and evidence-based clinical pathways to deliver exceptional outcomes for patients with complex chronic conditions.

Practice Info

• Lead an in-home multi-specialty polychronic care model in an assigned market.
• Each market is comprised of 5-10 territories led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists.
• 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.
• 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.
• This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel.

Responsibilities

• Lead daily high risk and concurrent review rounds.
• Provide direct supervision of front line clinical and operations team members, including regular shadowing/ride-alongs in the field.
• Oversee and delegate operational responsibility to Market Manager, to deliver on daily operations, such as patient engagement, scheduling, administrative oversight, strategic implementations, and P&L management.
• Provide direct and indirect patient care (including diagnosis and treatment of acute and chronic diseases).
• Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
• Conduct Peer to Peer consults with community, facility, and health plan partners.
• 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.

Compensation

• Competitive compensation
• Salaried
• 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

• Participate in Monogram On-Call rotation which will vary; e.g. 7 days on call minimum once/quarter.
• Provide coverage for other MPEs, during PTO or vacancy, as needed.

Requirements

• Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
• Willingness to become licensed in multiple states.
• MD (Medical Doctor) 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.
• Active, unrestricted state medical license required in each state within the market, and ability to obtain additional states as needed.
• Demonstrated experience applying evidence-based clinical criteria.
• Experience in multispecialty, geriatrics and/or value-based care.
• Advanced management and communication skills.
• Experience with high need Medicare Advantage and managed Medicaid populations.
• Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.