Learn more about one of the exciting benefits of joining the RISE Association.

Editor’s note: The Talent Hub is available to all RISE Association members. Click here to learn about membership benefits and how to join one or all of our communities.

It might be the best kept secret on the RISE Association member portal. When it comes to recruiting certain jobs for risk adjustment and Stars, for example, where can you go to find people with the right experience and skills to step into a job opening where the new hire must hit the ground running? There is no time to fully train and equip someone from scratch in these kinds of roles. And most recruiter firms are thin on resumes from interested and available candidates. That is why you want to be visible to the talent that already exists.

Also, if you are seeking that right next step yourself, where would you expect to see job openings in your particular area of specialization?  If you are a member of the RISE Association, check out the RISE Talent Hub.

Our advice: Dig beneath the surface of any job posting. On the face, it may look great or not as appealing, depending upon your assumptions, until you check it out. There is usually more than what meets the eye.

For example, consider the job opening below that is currently on the RISE Talent Hub for a Director, Risk Adjustment at AllCare IPA and AllCare Medical Group in Modesto, Calif.  As you’ll see, it lists responsibilities, essential skills, and the work environment.

But it’s always important to look deeper. The CEO of the medical group recruiting for the position told RISE that sometimes what’s listed in a job positing is not always a full description of the position.

“If they have interest, they should reach out and find out more,” he said, noting that the listed job description doesn’t mention that the medical group has a high staff retention rate (many staff have been employed for 10 to 20 years) because its focus is to create a great environment for great employees.

“We hold all-staff (all levels of the company) meetings bi-monthly and tell everyone everything that’s happening, opportunities and threats. That makes them part of the company and they grow in their knowledge of the industry. We also are quick to respond to good idea. If there is a good idea, we can take it from the idea stage to implementation immediately,” he said.

“We’re also all about results, and we promote and appreciate staff for results. We have grown approximately 10 percent annually for about 10 years in Medicare Advantage. We’re in a geographic area where there is lots of opportunity,” he said.

Featured Job Opening: Director, Risk Adjustment, AllCare IPA and AllCare Medical Group, Modesto, California

AllCare IPA and AllCare Medical Group are represented by over 1,000 private practice physicians and multiple contracted health plans, in Merced, San Joaquin, and Stanislaus Counties. AllCare was founded in 1989 and focuses on prevention of illness and promotion of a healthy lifestyle.

At AllCare, our commitment is to health through the caring partnership of patients, physicians, and medical professionals. We are dedicated to offering every member quality health care that not only meets their expectations but sets standards for caring, convenience, and accessibility.

The Role

AllCare is seeking a results-oriented and highly motivated Director, Risk Adjustment. In collaboration with internal and external sources, the Director of Risk Adjustment will play an essential role in performance management of existing risk adjustment activities, and implementation of new programs to enhance outcomes. In this critical and visible role you will report to our CEO.

Primary Responsibilities

  • Be the go-to person and subject matter expert on Risk Adjustment (HCC/RAF/STAR) process improvement. Oversee the operations in multiple local AllCare owned clinics with the goal to ensure accurate documentation of HCC diagnoses, and to maximize the value of STAR services provided.
  • Collaborate with external and internal partners to identify logical new interventions that have a high probability of optimizing HCC accuracy and STAR performance.
  • Support and coordinate HCC training through existing external trainers
    • Coordinate regular and ad hoc training for AllCare MD and NP staff
  • Back-up to the external trainers as needed.
  • Audit MD/NP results and incorporate necessary training to maintain high accuracy.
  • Analyze HCC and STAR data to develop interventions for enhanced results.
  • Propose intervention strategies to address future anticipated changes in HCC and STAR programs. 
  • Present HCC/RAF performance results and findings to internal leadership
  • Communicate with senior leadership, and other team members about important deliverables, barriers and opportunities
  • Interpret financial metrics
  • Maintain collaborative working relationships with internal and external contacts

Education and Experience

  • 5 + years risk adjustment experience at a management level in a capitated medical group, health plan or equivalent environment
  • Excellent working knowledge of HCC coding, including resources to remain well informed about future model changes
  • Good working knowledge of STAR measures, associated weightings and knowledge of impact to health plan partners
  • Ability to train HCC coding to clinicians
  • Excellent analytical ability to review data to identify opportunities for enhanced accuracy of HCC coding and STAR measures
  • 8+ years of experience in Managed Care, preferably in a capitated HMO environment
  • Track record for achieving results
  • Bachelor’s degree or equivalent required

Essential Skills and Abilities

  • Well connected to HCC industry (RISE, etc.)
  • Remain current on industry changes as it applies to HCC / STAR
  • Minimize RADV risk while maximizing the accuracy of HCC coding
  • Excellent interpersonal, with the ability to inspire and engender trust across all levels of an organization
  • High attention to detail, a strong ownership-ethic and intense focus on accuracy and accountability
  • Ability to work effectively with managers, providers, office staff, health plans and all other departments
  • Strong problem-solving and data analytical skills
  • Strong innovative skills to think “outside the box” for development of interventions to improve results and benefit our members
  • Ability to prioritize and to meet deadline
  • Excellent written and verbal communication skills

Work Environment/ Physical Demands

  • Normal office environment. Includes sitting, standing, operation of keyboard / telephone / computer, etc.  Requires normal range of motion, hearing and eyesight.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.