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Aetna Director, Medicare Risk Adjustment and Star Ratings in Wichita, Kansas

Req ID: 71859BR

Job Description

Leadership position that champions a culture committed to excellence in Medicare Risk Adjustment and Star ratings for Aetna's Heartlands/Midlands Market!! (IA, NE, SD, ND, CO, KS, MO, AR, S. IL) Identifies and drives an overall local market strategy for quality, cost management and coding/documentation performance improvement.

Fundamental Components included but are not limited to:

Coordinate, lead, and run multiple functional areas/units including full accountability for business/financial results within the local market.

Collaborates with national Medicare Risk Adjustment and Stars teams to execute on critical initiatives.

Responsible for identifying and executing strategies and operational tactics that support the achievement of high quality and Star ratings across the Heartland/Midlands market.

Conducts data analysis, in conjunction with national tools, to find opportunities that maximize quality and Stars outcomes.

Develops processes, work flows and other materials to document the operational and strategic components of initiatives.

Leads team of coding educators.

Leads cross functional work groups and partners with local and enterprise colleagues on Network, Clinical and Quality teams.

Leverages analytical data to identify and prioritize provider outreach strategies for Stars projects, coding education and Risk Adjustment initiatives.

Ensures successful results in medical record retrieval projects, prospective coding programs, provider education initiatives and dissemination of coding standard methodologies.

Coordinates with Provider Engagement Managers and RN program managers in performance management of quality, coding and Stars Ratings in Medicare value based contracts.

Engages with clinical team and providers as needed serving as an SME on Star rating measures.

Investigates operational issues and works with business partners to implement solutions.

Inspire change in order to improve performance results, organization efficiency and/or systems/quality/services.

Monitors and trends member complaints, grievances and appeals in the market and builds local activities to mitigate issues.

Produces content for training tools for external partners (e.g. brokers, providers) developed around market needs (CTM drivers, trends).

Qualifications Requirements and Preferences:

  • 5+ years experience with Medicare star ratings, quality, coding and risk adjusted revenue

  • Demonstrated leadership with project management, business process consulting, financial strategic analysis, strategic business planning, and/or risk management consulting.

  • Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity.

  • Proven experience successfully executing change in complex organizations.

  • Strong analytical skills, with the ability to review and manipulate data to draw conclusions

  • Ability to think strategically and to translate strategy into measurable goals

  • Proven relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously. Communication and presentation skills; experience addressing Senior Leadership

Additional Job Information:

Exceptional communications skills including ability to interact with a variety of external and internal audiences including senior management.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Quality Management

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.