Regional Executive Director, Performance
Position Purpose: The Regional Executive Director of Performance oversees the training and operations of the performance team in collaboration with the National Director of Quality and National Director of Risk Adjustment. Responsibilities include proactive planning, organization, and oversight of performance operations, ensuring the highest quality care and services are provided in the most efficient manner. This position focuses on achieving outcomes for the performance program operations, strategic implementation and execution of initiatives, cost benefit analysis, and respective overhead expense management.
Support: Works in collaboration to key stakeholders, large group and local chapter operations team. Reviews for clinical indicators and query providers to capture the severity of illness of the patient. Interacts with providers regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. Supports process improvement to enhance physician and staff workflow. Supports medical record data review/collection for appeals and exclusions at the time of data submission per contractual obligations. Participates in office/practice team huddles as appropriate. Works with SHCN Patient Registry and practice Electronic Health Record or paper record to support SHCN reporting and monitoring of quality performance and risk adjustment. Provide education and guidance for MIPS/QPP program. Oversee special assignments and projects that support and further organizational initiatives.
Performance: Collaborate with provider practices, local chapter operations team, and performance staff to enhance overall performance. Ensure appropriate reporting on benchmarks to provide timely and relevant information on overall effectiveness of strategic initiatives. Oversee the assessment of performance in relation to established goals and standards. Audit quality and risk adjustment reporting as necessary. Assist practices in EHR optimization for MIPS/QPP success. Coordinate with Performance Managers and Supervisors to develop performance improvement plans at the staff and practice level as appropriate. Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and HEDIS measures.
Strategy: Consults with the National Director of Quality, the National Director of Risk Adjustment, and other stakeholders on the development of goals and standards that align with the strategic plan of SHCN. Create implementation strategies to facilitate sustainable, effective program improvement. Analyze and interpret reporting, execution, and assess efficiency of program initiatives to reach year end targets. Anticipate issues, track and trend outcomes, and successfully develop mitigation plans as needed to achieve and/or exceed department and organizational goals.
Leadership: Develop and maintain collaborative partnerships with executive management and participate in business development. Communicate with Executive Leadership on program progress, status of tasks/initiatives, and process improvement opportunities. Provide department support through mentorship, experience, and allocation of additional resources as deemed appropriate and necessary. Build consensus in team environment with the highest level of professional and personal integrity and help foster a positive work environment.
Coaching: Plan, assign, monitor, and appraise employee’s job results. Oversee the training and field work of the performance team. Educate SHCN Performance Operations and practice staff on clinical workflow, risk adjustment, and quality measure best practices. Coaches the performance team on the effective design and implementation of plans for continuous improvement within physician practices. Assists in preparation of training materials (internal or external). Present to key stakeholders, vendors and large groups.
Education / Experience / Other Requirements
- Bachelor's degree or equivalent experience preferred.
- Medical Assistant certification or LPN license preferred.
Work Related Experience:
- 5+ years of healthcare management experience.
- Clinical background (Medical Assistant or LPN) with coding (HCC/MRA) experience preferred.
- Experience in quality and risk adjustment.
- Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements, as well as HEDIS.
- Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint.
Job Status: Full Time
Job Reference #: 6577