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Job Summary and Responsibilities

Will have oversight for Arkansas, Tennessee/Georgia, Kentucky and Ohio markets. Work-mode is flexible/remote; preferably reside either in the EST or in CST zones, and up to 25-50% professional travel may be involved.

+ Supports quality, clinical practice, safety, risk coding, compliance, patient experience and Health Information Management functions within the Value Hub (Clinically Integrated Networks/CINs).

+ Facilitates quality and patient experience performance across the SE Region Value Hub (VH) of CommonSpirit Health.

+ Demonstrates productive and organized leadership in the development and implementation of performance improvement plans and programs necessary to meet strategic objectives.

+ Conducts provider and quality incentive programs in the value hub.

+ Manages a team of managers/personnel with varying critical organizational roles.

+ Serves as market liaison, interfacing with internal clinical leaders and external payer partners for all things quality and risk for the value hub.

+ Through Risk Management/Auditor Manager, implements a risk adjustment coding department in appropriate Arkansas and Kentucky CIN.

+ Educate providers to improve documentation and coding practices, for accurate claims submissions and accurate reimbursement.

+ Continue to work closely with managers and providers to build relationships, establish trust and open communication related to documentation best-practices, accurate documentation and coding, and claims submissions

+ Participate/assist in pilot programs for concurrent and retrospective review processes. Assist in the creation of workflows and guidelines for these new processes.

+ Support the Risk Auditor Manager of closely working with the HCC Risk auditors to establish, and update daily workflows and audit processes. Ensure that auditors stay current on guidelines and best practices and maintain the highest level of ethics in their chart reviews and provider interactions. Use the weekly auditor’s roundtable to challenge each other and expand our knowledge on the most complicated areas of documentation and coding.

Job Requirements

+ Bachelors Degree in Nursing required

+ Current, unencumbered RN license in primary state of residence with ability to apply for multistate licensure (AR, KY, TN, GA, OH) per the NLC

+ 5 years leadership experience

+ Extensive CIN/Population Health Management experience required

+ Must have experience with risk adjustment coding and value based reimbursement models of payment

+ Knowledge of CMS, NCQA, ambulatory care, quality, and population health

Where You'll Work

Southeast Value Hub (SEVH) is a consortium of multiple Clinically Integrated Networks (CINs) of CommonSpirit Health in the state of Arkansas, Kentucky, SE Tennessee/NE Georgia and Ohio. SEVH closely partners with CommonSpirit Health's Population Health Services Organization (PHSO) through which tools and resources are shared and operationalized across the said markets in order to improve quality of care, decrease clinically unnecessary and avoidable costs, improve patient and provider experience through Value Based Agreements (VBAs) with governmental (CMS and state for Medicare Shared Savings-Accountable Care Organization/MSSP-ACO and Medicaid), private insurers (for MA, fully insured and health insurance exchange) and self-insured commercial populations of a total over 200,000 "lives."

The SEVH contains CINs that have industry's and CommonSpirit's best-practices in Risk Score performances in MSSP-ACO, Annual Wellness Visits (AWVs), year-over-year of successful record of managing/controlling avoidable costs in both governmental and commercial VBAs, ranked as one of the _Best-Places to Work_ in the state, one of the largest MSSP-ACOs in the industry, one of the CINs is a dual URAC-accredited entity in clinical integration and employer-based population health, and "a top-ranked ACO to know" in the nation by Becker's Healthcare, etc.

Pay Range

$52.02 - $77.38 /hour

We are an equal opportunity/affirmative action employer.