Medical Director (Value Based Care)

Are you a practicing physician with a passion for healthcare technology and a deep understanding of risk adjustment? We are seeking a Medical Director with extensive experience in risk adjustment to play a pivotal role in our organization. This Senior-level position is responsible for strategic leadership, oversight, and direction; reporting directly to CCO (Chief Clinical Officer). Responsible for designing and supporting the execution of a transition strategy that moves the organization to value-based care (managing populations). The medical director will develop relationships to achieve results, promote standardization and drive innovation by developing workflow and process mapping to design sustainable models. Additionally, the director will create the process, structure, policies, and teams necessary to succeed in a value-based model while creating workflow design and role responsibilities to optimize clinical outcomes.

Responsibilities:  

• Lead Risk Adjustment Initiatives: Oversee and guide the development and implementation of risk adjustment strategies to ensure accurate coding and optimal financial performance.
• Lead and Expand Provider Education Team: Spearhead the growth and management of the Provider Education team, overseeing the development and upkeep of accredited CME courses to meet evolving industry standards.
• Support Leadership: Provide leadership with reports and analysis on project progress and address any obstacles.
• Medical Expertise: Provide clinical expertise and insights to support the development of our healthcare IT products and solutions, focusing on enhancing risk adjustment capabilities.
• Data Analysis: Analyze patient data and medical records to ensure precise risk adjustment coding and compliance with regulatory standards.
• Cross-Functional Collaboration: Work closely with Quality Improvement (QI) and Clinical Operations teams, engaging with clinical coders, registered nurses, and mid-level practitioners on targeted projects to ensure seamless integration of initiatives.
• Enhance Vatica Platform: Communicate and collaborate effectively with product managers and IT developers to improve the Vatica platform and business systems.
• Training and Education: Develop and deliver training programs for internal teams and clients on best practices in risk adjustment and coding accuracy.
• Quality Improvement: Lead initiatives to improve data quality, coding accuracy, and overall risk adjustment processes within the organization.
• Regulatory Compliance: Oversee regulatory changes and ensure our risk adjustment practices comply with industry standards and guidelines.
• Value-Based Contract Optimization: Develop and execute a holistic strategy to optimize performance in value-based contracts, offering clinical insights to prioritize activities and refine implementation approaches.
• Stakeholder Engagement: Support internal and external communication …