Remote Risk Adjustment Coder Jobs in Hilton Head Island, SC

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) in Savannah, GA, to lead an in-home multi-specialty polychronic care model. This physician leader will improve patient well-being, quality of life, and health outcomes by overseeing daily clinical and business operations, providing direct patient care, and guiding market teams. The MPE will collaborate with Monogram Health's Multi-Specialty Platform and community partners to deliver exceptional outcomes through evidence-based clinical pathways and disease treatment.

Practice Info

• Lead an in-home multi-specialty polychronic care model in an assigned market.
• 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.
• Oversee 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.
• Review and approve APP, RN, SW, and PharmD plans of care.
• Overall accountability for reducing total cost of care and Medical Loss Ratio.
• 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.
• Provide clinical guidance and direction to Market teams to drive Population Health Management activities.
• Collaborate with Medical Economics, Finance, and other stakeholders to root cause and action against utilization trends impacting care and outcomes.
• Participate in Monogram On-Call activities.

Compensation

• Competitive salary and opportunity to participate in the company's bonus program.

Benefits

• Comprehensive medical, dental, vision and life insurance.
• Flexible paid leave and vacation policy.
• 401(k) plan with matching contributions.

Shift & Schedule

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