Risk manager Jobs in Fairfield, CA

Description : Job Summary :

The ED, Strategic Planning and Oversight, Risk Adjustment is responsible for overseeing daily RA operations across all function's areas (Retrospective Chart Operations, Prospective Operations, Reporting & Analytics and Provider Engagements. This role and team serve as a connection point across the organization and enterprise functions related to Risk Adjustment. As the Executive Director of the RA program, this role will report directly to the SVP of Risk Adjustment. The individual will also be responsible for overseeing initiatives and activities across all RA processes and for streamlining processes, plans, and organizational communication across RA sub-teams.

This role will oversee the delivery of al l Risk Adjustment programs and connections to business areas including Quality, Population Health, Clinical Operations, Revenue Integrity, Revenue Cycle, Compliance and Regulatory. Responsible for achieving Risk Adjustment program outcomes including business goals across departments, functions or regions. Oversees the program team, holding the team and team members accountable for results and guides the decisions of others regarding internal and / or external resource requests. Proactively monitors, identifies and mitigates risks, issues and trigger events within and across multiple interdependent programs by leveraging expertise and implementing changes. Oversees compliance of program activities by ensuring program plans and team members adhere to relevant policies and procedures. Oversees the alignment, buy-in, engagement and support of diverse program stakeholders. Champions the standards for vendor performance, provides direction for service improvements, and directs partnerships and contract negotiations with vendors.

Essential Responsibilities :

• Lead teams that will deliver coding guidelines and standards across the enterprise, delivery planning and process improvement functions across the Risk Adjustment teams and provide regulatory policy and risk management resourcing for the enterprise related to Risk Adjustment.
• End to End Program Management :

Oversees daily RA activities, and the operation of multiple units, ensuring timelines, regulatory requirements, and operational goals are being met.

Resolves barriers and facilitates communications between teams to ensure each role is aligned on the expectations for their respective tasks and the team meets all regulatory deadlines

Monitor all CMS and market-specific requirements to ensure compliance with federal and state regulations and leverage changes in regulatory requirements to inform future state RA strategy.

Communicate with senior leadership across all RA sub teams and ensure teams are aligned on program goals, execution timelines, and delegation of responsibilities.

Communicates with senior leadership on the key details of projects and programs to drive deliverables to effective execution

Tracks year over year process improvement through collaboration with reporting and analytics teams and drives initiatives to increase program accuracy and quality.

Anticipates and removes obstacles that impact performance; work with health plans and vendors to mitigate any risks or escalated issues

Acts as a thought leader on industry trends, benchmarks, and best practices; shares best practices within and across teams to drive improvement.

Basic Qualifications :

Experience

Education

License, Certification, Registration

Additional Requirements :

Demonstrated ability to lead end-to-end risk adjustment operations, effectively managing timelines, resources, and stakeholders.

Superior communication skills, essential for frequent interactions across all RA operational teams, adjacent team leaders in care and quality management, vendors, providers, and other relevant stakeholders.

In-depth familiarity with various value-based care programs, Lines of Business (LoBs), and comprehensive knowledge of regulatory and compliance standards across different markets, including Medicare, Medicare Advantage, Affordable Care Act (ACA) Marketplace, Commercial plans and Medicaid.

Experience in formulating and executing risk adjustment policies and strategies that drive organizational success and ensure regulatory compliance.

Preferred Qualifications :

Primary Location : California,Oakland,Ordway

Scheduled Weekly Hours : 40

Shift : Day

Workdays : Mon-Fri

Working Hours Start : 08 : 00 AM

Working Hours End : 05 : 00 PM

Job Schedule : Full-time

Job Type : Standard

Worker Location : Remote

Employee Status : Regular

Employee Group / Union Affiliation : NUE Executives|NUE|Non Union Employee

Job Level : Director / Senior Director

Department : Po / Ho Corp - HP PROD-OFFC of SR VP HP OPS - 7016

Pay Range : $243000 - $303750 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.

Travel : Yes, 10 % of the Time

Remote : Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest