MRA Physician Lead - CenterWell - Las Vegas, NV
Humana

Job Info

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Description

Humana's Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating over 175 centers across eight states under two brands: CenterWell & Conviva. Operating as a payor-agnostic, wholly owned subsidiary of Humana, our centers put the unique needs of seniors at the center of everything we do. Our Clinics offer a team-based care model where our physicians lead a multi-disciplinary care team supporting patient's physical, emotional, and social wellness.

At CenterWell Senior Primary Care, we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

Responsibilities

The Medicare Risk Adjustment (MRA) Physician Lead serves as a health-care professional and capable of handling a variety of health-related problems. The MRA Physician Lead has similar job duties as a Physician, namely focusing on outpatient medicine, continuity of care, health maintenance, and disease prevention. Keeps a medical history and medical records. Refers the patient to specialists as needed.

In addition to clinical responsibilities, the MRA Physician Lead will conduct activities specifically focused on improving Medicare risk adjustment documentation accuracy within his/her specific market. Activities will include but are not limited to the following:

• Develop strategies and execute plans to educate providers on coding and documentation accuracy
• Conduct chart reviews and 1:1 audit sessions with providers to improve documentation accuracy with a specific focus on new and low performing providers
• Meet regularly with coding manager to assess coder progress/concerns in pre-review process
• Monthly meeting with coders to provide education on chronic condition clinical indicators and chart review processes to ensure alignment between coders and Providers
• Develop and deliver provider trainings on various MRA conditions working with and utilizing resources throughout CDO - Training team, Quality Committee, CDO specialists (ex. Cardiology)
• Conduct MRA onboarding training for new providers
• Work with CDO quality committee to develop clinical pathways for various high risk conditions
• Partner with MRA team to develop/review suspect logic to identify undocumented chronic conditions based on claims and eCW data
• Review and analyze MRA data - DBI, HCC/patient, etc. - to identify areas of opportunity for improvement, training, education, etc.
• Advises executives to develop functional strategies (often segment specific) on matters of significance.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.

The MRA Physician Lead will spend 80% of their time clinically focused on direct patient care, with the remaining 20% of time dedicated to program initiatives.

EDUCATION/CREDENTIALS/REQUIREMENTS:

• Current unrestricted medical license in the state of Louisiana or willing to obtain a medical licenses in Louisiana prior to employment, and eligible and willing to obtain licenses in other states in the region of assignment, as required
• Graduate of accredited MD or DO degree; successful completion of an accredited ACGME/AOA family/internal/geriatric medicine residency program
• This role is considered patient facing and is a part of CenterWell's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

JOB RELATED EXPERIENCE:

• Minimum of two to five years of technical experience
• Minimum of two to five years directly applicable experience preferred
• Excellent communication skills; written and verbal, demonstrate a high level of skill with interpersonal relationships and communications with colleagues/patients; fully engaged in the concept of "Integrated team based care"
• Willingness and ability to learn/adapt to practice in a value based care setting
• Superior patient/customer service
• Basic computer skills, including email and EMR

REQUIRED SKILLS/COMPETENCIES:

• Doctor of medicine (MD) or a doctor of osteopathy (DO) degree (MD/DO); successful completion of an accredited ACGME/AOA family medicine/internal medicine residency program
• Board Certification or True Eligibility in Family Medicine, Internal Medicine or Geriatric Medicine with continued certification throughout employment. We recognize ABOM, AOA and ABPS certifications.
• Licensure requirements of the state of jurisdiction
• Experience managing Medicare Advantage patients with understanding of Best Practice in a coordinated care/value based relationship environment
• Knowledge of Medicare guidelines and coverage
• Knowledge of HEDIS quality indicators

Additional Information:

• Guaranteed base salary + quarterly bonus

• Excellent benefit package -health insurance effective on your first day of employment

• CME Allowance/Time

• Occurrence Based Malpractice Insurance

• Relocation and sign-on bonus options

• 401(k) with Employer Match

• Life Insurance/Disability

• Paid Time Off/Holidays

• Minimal Call

#physiciancareers

Scheduled Weekly Hours

40

This job has expired.