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Performance Manager
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Full-time
- Position Purpose: The Performance Manager oversees the training and field work of the performance team in collaboration with the Sr. Manager of Quality and Risk Adjustment, this position is responsible for the program development, hiring, training and field implementation in physician practices with opportunities for improved quality, risk adjustment and clinical workflow (referral management and population health management) performance.
- As a field manager, this position is a valuable resource to the Regional Performance Operations Team. Key Responsibilities: Reviews for clinical indicators and query providers to capture the severity of illness of the patient.
- Supports medical record data review/collection for appeals and exclusions at the time of data submission per contractual obligations.
- Works with SHCN Patient Registry and practice Electronic Health Record or paper record to support SHCN reporting and monitoring of quality performance and risk adjustment.
- Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and HEDIS measures Consults with the Sr. Manager of Quality and Risk Adjustment and other stakeholders on the development of goals and standards that align with the strategic plan of SHCN. Provides expertise to develop and sustain process improvements at all levels of the organization.
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