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Medicare Star/Risk Adjustment Lead

Primary Location: St Louis Park, MN
Additional Locations: MN-St Louis Park
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Description:

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 Star/Risk Adjustment Lead to support the growing Medicare business of our new joint venture health plan, Allina Health | Aetna. This is a highly collaborative role that will report to the local market Chief Medicare Officer and drive local Star/Risk Adjustment strategy and execution.






Fundamental Components:

Local quarterback with dual responsibilities in maintaining/improvingAllina Health | Aetna Medicare Star Ratings and Risk Adjustment; executes local Star and Risk Adjustment strategy inalignment 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

·May oversee embedded coder or coding educator with support from national team

·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


#LI-HH1



Background Experience:
·Health insurance/managed care
· 3+ years of Medicare

·Medicare Advantage experience 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 execute strategy and devise plans



Required Skills:
General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance

Functional Skills:
Products-Medical - Individual Medicare Advantage Plan, Quality Management - Quality Management

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)

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