Director, Quality & Risk Adjustment Operations

Job description

Director, Quality & Risk Adjustment Operations – Job Description

Employment Type: Full time

Level: Director+

Location: Remote; MN-based, highly preferred

Who we are:

At Herself Health, we’re on a mission to help women get more life out of life, together. We are building a new model of primary care for women 65+ to solve long-standing problems: rushed appointments, long wait times, and care that’s generalized rather than specialized towards women’s needs later in life such as post-menopausal care, bone density, weight management, and mental, social and emotional well-being.

Our patient-centric Primary Care clinics are dispersed across Minneapolis/St. Paul, MN. We are thrilled to serve the Twin Cities metro and Eagan. Our team of 100+ colleagues is on a mission to innovate the primary care landscape for women 65+. We’re seeking like-minded individuals who share this passion to join us!

About you:

As we grow our early team, we are seeking strategic thought leaders who have a passion for building and innovating. We foster a culture of collaboration, excellence, and willingness to roll up our sleeves and learn as we grow. We have a customer first mindset, and we are looking for team members who share that. Our ideal candidates have strategic prowess and the ability to use data to build best practices and implement great ideas in collaboration with our team and our community.

About the Director, Value Based Care Operations Role:

This leader is responsible for developing the strategy and leading the execution of Herself Health’s HEDIS Quality and Burden of Illness (aka Risk Adjustment) programs to drive high quality outcomes and documentation for our patients. This leader will work in a collaborative dyad partnership with the Chief Clinical Officer to ensure the accuracy and completeness of risk adjustment coding activities, and clinically effective strategies to address quality of care gaps for Herself Health patients. This leader will partner closely with the payer strategy and clinical operations teams to achieve contractual performance targets for Herself Health’s value-based care contracts. This role is fast-paced and highly visible within our internal leadership team, our board and investors, and external partnerships.

Location Requirements:

While candidates located in Minnesota are strongly preferred, we welcome applications from individuals who are located and legally authorized to work in the United States.

Essential Functions:

• Program performance management: own the strategic vision, develop and execute the strategic plan, and manage the day-to-day performance of the Quality and BOI programs to drive high quality outcomes for our patients and deliver on our contractual performance targets
• Team leadership: provide strategic direction, inspiration, coaching, and enablement for the VBC leaders, who oversee teams of Care Coordinators and Provider Educators, responsible for the day-to-day performance of our VBC operations; lead through influence in driving adoption of best practices by providers and clinical teams across the practice
• Practice subject matter expert: serve as the subject matter expert on HEDIS and risk adjustment through prior experience and staying informed on CMS technical and programmatic changes and communications
• Vendor management: own the strategic partnerships with key vendors that support our quality and BOI programs; ensure compliance and alignment to contractual obligations and drive improvement efforts with the vendor, as needed

Qualifications and Skills:

• Authorized to work in the United States
• Bachelor’s Degree required; Master’s Degree highly preferred
• Certified Coding Specialist is nice to have, but not required
• Expert knowledge of CMS’ HEDIS Quality program and measures
• Expert knowledge of CMS regulatory rules and coding guidelines for Medicare Advantage risk adjustment coding
• Ability to dig deep into data to understand trends and drivers of performance
• Ability to effectively lead through influence and change
• Strong communications and presentation skills
• Experience working cross-functionally with providers, care teams, operations, and finance
• Experience working in Electronic Medical Record (EMR) systems; experience with Athena is desirable
• 3+ years of HEDIS Quality and Risk Adjustment experience
• 5+ years of experience leading teams
• Ability to travel up to 25% to MN clinics

We support Equal Employment Opportunities (EEO). We are committed to an inclusive workplace. We do not discriminate based on race, religion, color, national origin, gender identity or expression, age, marital status, veteran status, disability status, parental status, political affiliation, or any other status protected by federal, state, or local laws.

All employees of Herself Health are expected to fully understand and abide by the practice’s compliance policies and procedures. Employees are provided training upon hire and annually and regularly notified of changes as needed. It is expected that all employees will report any suspected violations of any federal or state laws to their direct supervisor, Human Resources, or the Compliance Officer.