We are seeking qualified candidates in the St. Louis Park, MN market for this extraordinary role
Allina Health and Aetna have partnered to transform the way Minnesotans experience health care – improving quality, emphasizing whole-person wellness, and driving down costs. Aetna is hiring a local Director of Stars and Risk Adjustment to support the growing Medicare business of our joint venture health plan, Allina Health | Aetna. This is a highly collaborative role that will report to the Chief Medicare Officer and drive local Star/Risk Adjustment strategy and execution.
The individual in this role will act as local quarterback with dual responsibilities in maintaining / improving Allina Health | Aetna Medicare Star Ratings and Risk Adjustment. They will execute local Star and Risk Adjustment strategy in alignment and collaboration with Aetna Medicare Segment best practices / resources.
- Work across local market leadership to establish and champion a culture committed to Star and Risk Adjustment excellence
- Focus on quality, executing on national initiatives for the local joint venture plan
- Identify local market Star and Risk Adjustment strategies; manage local quality programs (e.g., PEP)
- Monitor and trend member complaints, grievances and appeals and support local activities to mitigate issues
- Manage and direct local vendors
- Ensure compliance across various elements to minimize risk
- Conduct data analysis, in conjunction with national tools, to identify opportunity areas and paths on track; assure member metrics are met
- Identify which provider contracts to prioritize with HEDIS and Risk Adjustment initiatives; develop strategy in which members/value-based contracts/providers get embedded coder training
- Oversee local Revenue Integrity Manager in executing key strategies and coding education opportunities
- Produce content for training tools for agents developed around market needs (e.g., CTM drivers or RAF trends)
- Engage with clinical team and specific clinics, medical groups, or hospitals; attend joint operating committee meetings; support engagement managers and RN program managers
- Support local market colleagues in ensuring strategic and optimal bids; attend/host trainings
- Manage additional dock-in points such as Medicare service operations, product, sales, network, performance, and medical economics
- Health insurance / managed care background
- 3+ years of Medicare experience
- Medicare Advantage expertise with heavy focus in Star/Risk Adjustment areas
- Strong data and financial analysis acumen
- Fluent in Quality standard principles including Stars, HEDIS and Medicare Risk Adjustment
- Ability to foster trust / relationships with internal partners and key provider groups
- Ability to develop and execute strategy, and devise plans
- Influencing and negotiation skills
- Collaboration and ability to drive results through multiple partner organizations, internal and external
- Strategic thinking
- Clinical and/or coding certification(s)
- Bachelor's degree or equivalent experience
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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