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Manager of Quality - Risk Adjustment Programs at HCA Healthcare
Campbell, CA 95008, USA - Full Time
Skills Needed
Leadership, Licensure, Cpc, Presentation Skills, Regulatory Requirements, Incentive Programs
Qualification
Graduate
Manager Capital Project Management at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Expenses, Interpersonal Skills, Color, Excel, Completion, Contractors, It, E Builder, Health Systems, Multi Disciplinary Teams, Cost Savings, Purchasing Power, Construction, Collaboration, Power Bi, Healthcare Design
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Senior Automation Analyst at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Software Solutions, Kpi, Automation, Project Plans, Itg, It, Machine Learning, Statistics, Business Value, Architecture, Business Operations, Version Control, Color, Software Design Patterns, Technology Evaluation, Design, Ownership, Scripting, Leadership, Maintenance
Qualification
Graduate
EHR Application Support at BJC HealthCare
St. Louis, MO 63110, USA - Full Time
Skills Needed
Ged
Qualification
Diploma
Experience Required
Minimum 2 year(s)
Contract BI Specialist at HCA Healthcare
Brentwood, TN 37027, USA - Full Time
Skills Needed
Microsoft Office, Reporting Requirements, Ethics, Color, Technology, Teradata, Microsoft Sql Server, Access, General Ledger, Databases, Excel, Sql, Google Cloud Platform, Operations, Project Work, Revenue Cycle, Continuing Education, Business Operations
Qualification
Graduate
Experience Required
Minimum 3 year(s)
Division Vice President of Clinical Education at HCA Healthcare
Fort Lauderdale, FL 33301, USA - Full Time
Skills Needed
Clinical Education, Leadership, Acute Care, Organizational Development
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Senior System Educator at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Instructional Design, Meditech
Specialization
Nursing required
Qualification
Graduate
Staff Data Modeler - Hybrid at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Data Models, Data Products, Color, It Governance, Communication Skills, Thinking Skills, Operations, Leadership, Python, Architecture, Cloud, Construction, Analytics, Computer Science, Metadata Management, Large Scale Systems
Specialization
Computer Science
Qualification
Graduate
Data Modeler at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Database, Metadata Management, Python, Analytics, Decision Making, Architecture, Thinking Skills, Operations, Version Control, Travel, Computer Science, It Governance, Data Products, Construction, Design, Sql, Communication Skills, Color
Specialization
Computer Science
Qualification
Graduate
Consulting Database Administrator at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Tuning, Windows Server, Software Installation, Process Automation, Infrastructure, Color, Design, Automation, Maintenance, Critical Systems, Job Skills, Leadership, Scripting Languages, Database Maintenance, Human Error, Interpersonal Skills, Developers, Teamwork
Qualification
Graduate
Experience Required
Minimum 7 year(s)
Nursing Regulatory and Compliance Director at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Associate Automation Engineer at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Testing, Version Control, It, Continuous Delivery, Design, Business Operations, Business Value, Continuous Integration, Systems Engineering, Automation, Diverse Groups, Six Sigma, Rest, Machine Learning, Itg, Programming Languages
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Anesthesia Tech I at BJC HealthCare
St. Louis, MO 63110, USA - Full Time
Skills Needed
Ged
Qualification
Diploma
Experience Required
Minimum 2 year(s)
Maternal-Fetal Medicine Physician at OSF Healthcare
Evergreen Park, IL 60805, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Analytics Program Manager at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Analytics, Strategic Initiatives, Patient Care, Project Delivery, Color
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Special Education Teacher at EDU Healthcare
San Tan Valley, AZ 85140, USA - Full Time
Skills Needed
Special Education, Children
Qualification
Graduate
UC Engineer at HCA Healthcare
Kansas City, MO 64131, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Director Design Engineering at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Html, Javascript, Mastery, Risk, Scalability, Front End Development, Ux, Css, Human Computer Interaction, Git, Product Design, Mobile Platforms, Design, Design Engineering, Computer Science, Prototyping
Specialization
Computer science design human-computer interaction or related field required
Qualification
Graduate
Vice President Provider Contracting and Compensation at OSF Healthcare
Peoria, IL 61602, USA - Full Time
Skills Needed
Certified Compensation Professional, Compensation Strategies, Teams, Incentive Programs, Interpersonal Skills, Healthcare Management, Regulatory Compliance, Performance Metrics, Regulations, Assessment, Management Skills
Specialization
Healthcare administration human resources or related field
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Microbiology Coordinator at HCA Healthcare
Dallas, TX 75240, USA - Full Time
Skills Needed
Biology, Compassion, Team Building, Financial Performance, Quality Improvement, Communication Skills, Groups, Dignity, Work Allocation, Reagents, Chemistry, Medical Technology, Color, Correlation, Regulatory Compliance, Operations, Microbiology, Training
Specialization
Biology, Chemistry, Medical Technology, Technology
Qualification
Graduate
Experience Required
Minimum 3 year(s)
Manager of Quality - Risk Adjustment Programs at HCA Healthcare
Campbell, CA 95008, USA -
Full Time


Start Date

Immediate

Expiry Date

03 Aug, 25

Salary

163467.2

Posted On

04 May, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Leadership, Licensure, Cpc, Presentation Skills, Regulatory Requirements, Incentive Programs

Industry

Hospital/Health Care

Description

Salary Estimate: $108992.00 - $163467.20 / year
Learn more about the benefits offered for this job.
The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

JOB SUMMARY AND QUALIFICATIONS

GENERAL SUMMARY OF DUTIES: Reporting directly to the CEO for PPMSI, this role leads all aspects of the Quality and Risk Adjustment programs for the SCCIPA network including working closely with health plan partners, the physician network and internal stakeholders to develop and implement a high-performing and compliant quality and risk adjustment program. The Manager’s primary focus is to develop, implement and oversee all quality and risk adjustment related initiatives essential to the MSO services PPMSI offers to its IPA networks. Programs include IHA Pay for Performance, CMS 5 Star, Shared Savings incentive programs and Risk Adjustment.

KNOWLEDGE, SKILLS AND ABILITIES:

  • Experience in Project Management including work plan creation, budget and resourcing preferred
  • Minimum 5 years in management position leading Quality and Risk Adjustment programs preferred
  • Licensure: CPC, CRC and CPQH required; LVN or RN preferred
  • Ability to build a high-performing quality and risk adjustment team exemplifying PPMSI and SCCIPAs Guiding Principles, and achieving the Mission of HCA
  • Possess excellent written, verbal and interpersonal communication skills utilizing utmost discretion with sensitive and confidential information
  • Effective and persuasive presentation skills on complex topics to leadership, internal stakeholders and physicians
  • Working knowledge of risk adjustment documentation and coding requirements
  • Ability to research Pay for Performance and HCC issues; read, analyze, and interpret technical procedures and regulatory requirements
  • Ability to analyze health plan Quality, Shared Savings and Pay 4 Performance health plan exhibits
  • Expert user of Cozeva
  • Familiarity with a wide variety of EMRs
  • Ability to work independently, organize time, set priorities to meet established deadlines
  • Comfortable speaking, reporting and providing internal team trainings and Provider even trainings
Responsibilities

DUTIES INCLUDE BUT NOT LIMITED TO:

Quality:

  • Develops dashboard reporting by health plan to report, monitor and track performance against health plan quality measures
  • Accountable for developing and executing work plan to achieve health plan quality metrics and develops performance improvement plans where indicated performance is trending off-track
  • Accountable for understanding health plan incentive programs, developing a dashboard of maximum opportunity by plan and progress towards achieving incentive
  • Ability to communicate and train internal teams and network physicians on current performance trend and actions to achieve health plan identified goals
  • Ability to provide training sessions in small and large physician settings
  • Is considered expert user of Cozeva system and data, using data to drive reporting results, improvement plans and communication/training to internal staff and network physicians.
  • Ensures encounters are submitted to health plans timely, accurately and completely, identifying and implementing improved workflows as needed
  • Documents the Quality program’s cross-functional workflows and ensures PPMSI stakeholders understand accountability.
  • Assumes role as lead representative for SCCIPA and PPMSI on health plan JOC meetings
  • Accountable for reporting results and intended action plans to PPMSI senior leadership and SCCIPA Board of Directors

Risk Adjustment:

  • Accountable for leading a high-performing and compliant risk adjustment program including proper capture/recapture of HCCs
  • Ability to analyze and maximize the use of Cozeva data to understand the risk burden of SCCIPA membership
  • Develops a performance dashboard to track progress on Annual Wellness Visits, Members Without Visits, HCC recapture, RAF score trend and other critical program elements.
  • Develops training materials and work session curriculum for physician meetings; reviews physician’s performance metrics; identifies performance opportunities and support solutions
  • Leads training sessions for internal teams, such as Network Provider Representatives, to ensure Representatives are skilled in reviewing basic quality and risk adjustment dashboards and performance results
  • Accountable for understanding and estimating current RAF score
  • In coordination with Chief Financial Officer, analyzes and estimates risk adjustment accrual
  • Develops and coordinates member outreach programs to ensure members with chronic and acute medical conditions are properly managed and monitored by the SCCIPA network, and appropriate diagnosis are captured in the medical record
  • Uses Cozeva data to understand suspecting data, and ensures that information is shared w/the appropriate physician
  • Accountable for successfully submitting HCCs by CMS assigned submission dates
  • Accountable for ensuring rejections are worked timely and systematically, identifying and fixing root causes where needed
  • Ensures supplemental file information is submitted
  • Leads chart chase activities, developing a cost-effective targeted approach based on anticipated ROI
  • In coordination with Network Provider Representatives, works with network physicians to gain view only access to EMRs for efficient quality and risk adjustment chart reviews
  • Document program workflows and cross-functional accountability, ensuring stakeholders understand accountability and meet deliverables and timelines

WHAT YOU WILL NEED IN THIS ROLE:

EDUCATION: Bachelor Degree from a four-year college or university required
EXPERIENCE: Minimum of 3 years of previous experience in a managed care organization or other comparable experience for Quality Improvement P4P, CMS 5 Star, and CMS HCC required
Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare’s commitment to the care and improvement of human life.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
“The great hospitals will always put the patient and the patient’s family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Manager of Quality - Risk Adjustment Programs opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status

Manager of Quality - Risk Adjustment Programs at HCA Healthcare
Campbell, CA 95008, USA - Full Time
Skills Needed
Leadership, Licensure, Cpc, Presentation Skills, Regulatory Requirements, Incentive Programs
Qualification
Graduate
Manager Capital Project Management at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Expenses, Interpersonal Skills, Color, Excel, Completion, Contractors, It, E Builder, Health Systems, Multi Disciplinary Teams, Cost Savings, Purchasing Power, Construction, Collaboration, Power Bi, Healthcare Design
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Senior Automation Analyst at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Software Solutions, Kpi, Automation, Project Plans, Itg, It, Machine Learning, Statistics, Business Value, Architecture, Business Operations, Version Control, Color, Software Design Patterns, Technology Evaluation, Design, Ownership, Scripting, Leadership, Maintenance
Qualification
Graduate
EHR Application Support at BJC HealthCare
St. Louis, MO 63110, USA - Full Time
Skills Needed
Ged
Qualification
Diploma
Experience Required
Minimum 2 year(s)
Contract BI Specialist at HCA Healthcare
Brentwood, TN 37027, USA - Full Time
Skills Needed
Microsoft Office, Reporting Requirements, Ethics, Color, Technology, Teradata, Microsoft Sql Server, Access, General Ledger, Databases, Excel, Sql, Google Cloud Platform, Operations, Project Work, Revenue Cycle, Continuing Education, Business Operations
Qualification
Graduate
Experience Required
Minimum 3 year(s)
Division Vice President of Clinical Education at HCA Healthcare
Fort Lauderdale, FL 33301, USA - Full Time
Skills Needed
Clinical Education, Leadership, Acute Care, Organizational Development
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Senior System Educator at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Instructional Design, Meditech
Specialization
Nursing required
Qualification
Graduate
Staff Data Modeler - Hybrid at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Data Models, Data Products, Color, It Governance, Communication Skills, Thinking Skills, Operations, Leadership, Python, Architecture, Cloud, Construction, Analytics, Computer Science, Metadata Management, Large Scale Systems
Specialization
Computer Science
Qualification
Graduate
Data Modeler at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Database, Metadata Management, Python, Analytics, Decision Making, Architecture, Thinking Skills, Operations, Version Control, Travel, Computer Science, It Governance, Data Products, Construction, Design, Sql, Communication Skills, Color
Specialization
Computer Science
Qualification
Graduate
Consulting Database Administrator at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Tuning, Windows Server, Software Installation, Process Automation, Infrastructure, Color, Design, Automation, Maintenance, Critical Systems, Job Skills, Leadership, Scripting Languages, Database Maintenance, Human Error, Interpersonal Skills, Developers, Teamwork
Qualification
Graduate
Experience Required
Minimum 7 year(s)
Nursing Regulatory and Compliance Director at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Associate Automation Engineer at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Testing, Version Control, It, Continuous Delivery, Design, Business Operations, Business Value, Continuous Integration, Systems Engineering, Automation, Diverse Groups, Six Sigma, Rest, Machine Learning, Itg, Programming Languages
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Anesthesia Tech I at BJC HealthCare
St. Louis, MO 63110, USA - Full Time
Skills Needed
Ged
Qualification
Diploma
Experience Required
Minimum 2 year(s)
Maternal-Fetal Medicine Physician at OSF Healthcare
Evergreen Park, IL 60805, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Analytics Program Manager at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Analytics, Strategic Initiatives, Patient Care, Project Delivery, Color
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Special Education Teacher at EDU Healthcare
San Tan Valley, AZ 85140, USA - Full Time
Skills Needed
Special Education, Children
Qualification
Graduate
UC Engineer at HCA Healthcare
Kansas City, MO 64131, USA - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Director Design Engineering at HCA Healthcare
Nashville, TN 37203, USA - Full Time
Skills Needed
Html, Javascript, Mastery, Risk, Scalability, Front End Development, Ux, Css, Human Computer Interaction, Git, Product Design, Mobile Platforms, Design, Design Engineering, Computer Science, Prototyping
Specialization
Computer science design human-computer interaction or related field required
Qualification
Graduate
Vice President Provider Contracting and Compensation at OSF Healthcare
Peoria, IL 61602, USA - Full Time
Skills Needed
Certified Compensation Professional, Compensation Strategies, Teams, Incentive Programs, Interpersonal Skills, Healthcare Management, Regulatory Compliance, Performance Metrics, Regulations, Assessment, Management Skills
Specialization
Healthcare administration human resources or related field
Qualification
Graduate
Experience Required
Minimum 5 year(s)
Microbiology Coordinator at HCA Healthcare
Dallas, TX 75240, USA - Full Time
Skills Needed
Biology, Compassion, Team Building, Financial Performance, Quality Improvement, Communication Skills, Groups, Dignity, Work Allocation, Reagents, Chemistry, Medical Technology, Color, Correlation, Regulatory Compliance, Operations, Microbiology, Training
Specialization
Biology, Chemistry, Medical Technology, Technology
Qualification
Graduate
Experience Required
Minimum 3 year(s)

Healthcare Jobs in USA

The healthcare sector in the United States is a vast and dynamic field, offering a multitude of career opportunities. From clinical roles to administrative positions, the industry caters to a wide range of professionals. As per the stats, there will be 600,000 job vacancies in the healthcare sector by 2030. The growth of this sector is driven by an aging population, advances in medical technology, and ongoing public health initiatives. This environment creates a fertile ground for job seekers - from new graduates to experienced professionals—to find rewarding careers that make a significant impact on community health and well-being.

Healthcare Job Market in USA

The U.S. healthcare job market is robust and consistently expanding. Key factors contributing to this growth include:

  1. Aging Population: Increased need for chronic disease management, long-term care, and specialized medical services.
  2. Technological Advancements: Innovations in telemedicine, electronic health records, and medical devices are reshaping the way healthcare is delivered.
  3. Policy and Regulatory Changes: Recent healthcare reforms and policy updates have spurred investments in health infrastructure, leading to more job openings.
  4. Diverse Career Opportunities: The market spans clinical care, research, administration, and support services, offering varied pathways for career development.

High in-Demand Healthcare Job Roles in USA

Several roles are particularly sought-after in the U.S. healthcare landscape:

  1. Nurse Practitioner
  2. Physician Assistant
  3. Speech-Language Pathologist
  4. Veterinarian
  5. Nurse Anesthetist
  6. Veterinary Technologist and Technician
  7. Physical Therapist

Top Healthcare Companies Hiring Foreign Nationals in USA

Many leading healthcare organizations in the United States recognize the value that internationally trained professionals bring to the industry. Top companies known for hiring foreign nationals include:

  1. Mayo Clinic
  2. Cleveland Clinic
  3. Johns Hopkins Medicine
  4. Kaiser Permanente
  5. HCA Healthcare
  6. Ascension Health
  7. Tenet Healthcare
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