Senior Hcc Risk Adjustment Coder Jobs in Conway, SC

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 The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care (VBC) principles. This market/center-specific role requires flexibility to adapt responsibilities as needed and demands a unique blend of clinical management, financial/business acumen, and strategic partnership to optimize patient care and business outcomes.

Relocation and sign on bonus available.
 

KEY RESPONSIBILITIES 

Leadership & Organizational Management:

• Understand organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance
• Interview, hire, and supervise clinical teams to staff and develop a high-quality clinical team with strong engagement, patient-first culture, and talent retention
• Closely engage and communicate with clinicians and care teams, conducting weekly onsite center visits, holding regular individual 1:1s and clinician pod meetings, and actively participating in monthly leadership meetings
• Deeply understand, support, and improve primary care clinician performance through understanding of individual & care team context, effective use of data, and effective coaching of clinicians and care teams
• Engage in regular market performance (clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical initiatives
• Champion our senior-focused primary care strategic vision and initiatives and foster stakeholder relationships, including health plan partners, healthcare providers (e.g. specialists, hospitals) and social services, to improve our community of care locally
• Represent CenterWell/Conviva brands in local communities and related media activities while collaborating with the recruitment team to build and network a pipeline of high-quality primary care clinicians (physicians, APPs, MAs, and other clinical professionals)
•  Utilize clinical performance dashboards and data tools to support stack ranking, performance analysis, and targeted strategy development
•  Foster a culture of continuous learning and professional growth among clinical teams

Clinical/Patient Management:

• Foster a robust patient-centered and value-based clinical vision, strategy, and culture locally that orients care teams around excellence in patient care, teamwork, outcomes
• Deliver leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization
• Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments are accurate and that performance improvement and coaching initiatives are precise
• Identify critical issues for high-risk patients during case reviews & other forums, and model and drive clinical excellence
• Conduct root cause analysis of care opportunities from both individual, team, and systems perspectives and partner with clinical and operational colleagues to improve high-reliability care as a team
• Ensure clinicians effectively co-manage high-risk episodes of care and patients with partnered Care Integration Team (CIT) resources and programs for transitions of care management (TCM), high-risk patient management (HRPM), and social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization
• Monitor and manage daily patient care and initiatives to improve team-based key performance indicators (KPIs), such as patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals
• Personally deliver high-quality primary care and demonstrate a high degree of patient care ownership and clinical excellence in age-friendly senior primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management
• Spend 20–50% of time on direct patient care, with remaining time dedicated to administrative responsibilities. The percentage of time may vary by market needs and by staffing levels throughout the year
• Support clinical quality performance improvement in areas such as MRA, Stars, and prevention of unnecessary utilization through provider education and coaching
• Promote team-based care delivery and foster collaboration across interdisciplinary teams

Dyad Partnership:

• Collaborate with operational leaders (Associate Operations Director and/or Market President) and Shared Services partners to align on clinical and operational goals, strategic planning, and budgeting
• Maintain regular communication to align on performance, strategies, and team communication and management, ensuring unified decision-making and consistent messaging for cohesive leadership
• Work together towards common goals that support the mission, vision, values, and overall patient experience outcomes, managing clinic/market dynamics and engagement
• Partner on strategic and operational insights, including capital and operational budgeting, and monitor clinical & financial performance and metrics
• Review clinician schedules and incentive plans to align with patient care access and management goals

Use your skills to make an impact
 

Required Qualifications:

• Graduate of an accredited medical school (MD/DO) with a current medical license, maintaining licensure requirements of the state of jurisdiction
• Board Certification in Family Medicine, Internal Medicine or Geriatric Medicine
• Minimum five years of experience in outpatient practice, with clinical experience in primary care, senior health, and value-based care (VBC)
• Minimum three years of experience successfully leading clinicians in a leadership role with demonstrated impact on clinician talent, culture, and performance, and effective partnership with operations and supporting teams
• Skilled in use of clinical technology platforms and resources, such as EMR systems (e.g. athenahealth, Epic, eClinicalWorks), voice documentation tools (e.g. Dragon, Abridge), and clinical evidence & pathway resources (e.g. UpToDate)
• This role is considered patient-facing and is part of CenterWell’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
• Candidates selected for this job will be required to adhere to Humana’s flu vaccine policy

Additional Information

• 60K sign on bonus
• Relocation offered (if needed)

Social Security Task
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. 
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Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$310,000 - $368,500 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
 About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being. About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.