St. Luke’s Health Partners (SLHP) has an exciting opportunity for a Manager of Risk Adjustment to join our team in Boise, Idaho! The St. Luke’s Health Partners Manager is primarily focused in multiple disciplines with clearly defined parameters and goals. The position is responsible for execution and oversight of clinical discernment as it relates to the complete and accurate reflection of the illness burden of the population for which the Network is jointly accountable.
This role will manage a team of clinical discernment specialists (LPNs), enhance/improve current clinical discernment workflows, and provide support to the Population Health function by providing ideas to better serve participating providers and providing pertinent risk adjustment insight utilizing data and analytic tools. The Manager is expected to regularly communicate assessments, gap analysis and progress and to keep abreast of industry developments by reviewing CMS guidelines and industry updates to maintain their risk adjustment industry knowledge.
Manages the daily operations of the department, including maintaining appropriate staffing levels and assignments to meet the needs of the department
Provides leadership, guidance, counseling and continuing education to staff. Selects, develops, coaches, mentors, and assesses performance of staff. Works with staff to promote resolution of conflict and counsels staff when standards are not met
Will, engage, manage and monitor communications and interactions with relevant stakeholders
Works collaboratively with key stakeholders to achieve identified goals
Will maintain a working knowledge of regulations and related contracts and agreements impacting care delivery
May perform concurrent review on all assigned patients
May discuss cases as appropriate with relevant stakeholders
Responsible for assisting in the development and implementation of programs
Responsible for developing and supporting a collaborative relationship providers/physicians ensuring they meet the quality and efficiency standards
Develops program specific reports, as required. Collect data and present information as required
Directly manage, assess and evaluate specified department staff. Serve as a first line resource for department staff
Performs other duties and responsibilities as assigned
Bachelor’s degree or 4 years additional experience in lieu of Bachelor’s degree
5 years’ relevant experience
Demonstrated leadership and management experience
Strong clinical background in outpatient and inpatient settings
Strong problem solving ability
Strong written and verbal skills including presentation skills
Strong relationship building and collaboration skills
Data analytic skills utilizing MS Office and reporting frameworks
Knowledge of value-based care
Knowledge and understanding of HEDIS measures
Knowledge and understanding of Medicare Advantage Star performance measures
Specific knowledge of CMS and HHS HCC applications
Willingness to pursue and maintain CRC certification
ABOUT ST. LUKE’S HEALTH PARTNERS
St. Luke’s Health Partners is an Idaho-based financially and clinically integrated network of providers who share a vision to help its members achieve the best possible health at the lowest total cost of care. SLHP is accountable for the management of medical spend and quality outcomes of defined populations through value-based agreements with payer partners. The selective network of nearly 2,800 providers is currently serving more than 160,000 Idahoans.
SLHP’s corporate office is based in beautiful Boise, Idaho. Our mild, four season climate means you can play outdoors year-round. Whether you prefer leisurely walks along the river or heart-pounding climbs up a sheer cliff- there is always something to do after work. An exciting mix of urban and outdoor life defines Idaho’s culture, you can ski in the morning and watch a college sporting event at night. It is a great state to raise a family and forge lasting relationships. The cost of living is low, and quality of life is high.
- St. Luke’s Health Partners is an equal opportunity employer without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.