HCC Program Manager

Description

JOB PURPOSE:
To effectively interface with provider partners to successfully monitor and implement HCC initiatives. Will provide risk adjustment expertise as well as administrative oversight to ensure successful integration of SCAN's HCC initiative ESSENTIAL JOB RESULTS:
Maintain a comprehensive tracking and management tool (i.e. Physician Group HCC Business Plan) for assigned network. Track all HCC activities for all assigned medical groups and insure that all tasks are completed in a timely manner. Correlate activities, processes and HCC results/ metrics to evaluate outcomes.

Develop an understanding of the encounter data transmission processes for all groups and their affiliated capitated hospitals, and assist in identification of problem areas and solutions to ensure that SCAN volume and quality targets are met or exceeded.

Develop an understanding of HCC tools created for provider partners to promote the use of those tools during HCC discussion with provider partners.

Effectively manage HCC staff to ensure initiatives and projects are completed in a timely manner.

Develop innovative strategies to assist provider partners in attaining accurate member risk scores as well as seeing and treating members for their chronic conditions.

Coordinate HCC activities with other departments in SCAN including Informatics, and the SCAN Medical Directors.

Participate in HCC planning in all expansion opportunities and provide the structure for a successful regional or group expansion to have HCC plan in place. Coordinate CMS Data Validation activities, including record selection, tracking and submission, in conjunction with the HCC Tools Manager Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.

Contributes to team effort by accomplishing related results as needed

Requirements

Bachelors Degree in Business Administration
Five years in Health Care Management required
Understanding of ICD-9 Coding
*Supervisory experience required
Proficient computer skills
Excellent verbal and written skills
Must be able to do group presentations
Must understand Medical Group dynamics
Must have managed care experience
CONDITIONS OF WORK:

*Works in cubicle or office in smoke free environment
*Travel to provider sites
*Work Schedule 8 am - 5 PM, occasional overtime required including weekends