Job Summary

Under general direction, is a liaison for health plan initiatives with physician hospital organizations, physician organizations state-wide and community entities.  Partners with internal teams to develop and implement strategic initiatives.  Manages and coordinates large multi-faceted projects in an organized and cost effective manner.  Responsible for all disease burden related activities and driving improvement for the integrated delivery system.

. Essential Functions

Partners with internal teams and serves as a network and community liaison for strategic initiatives, training and Programs. 

Assesses, analyses, plans, implements and evaluates of multiple interventions, programs and data in support of Network efficiency, health outcomes and patient experience.

Identifies, monitors, coordinates and manages multiple projects.  This includes project scope, targets, timelines, resource requirements/costs, milestones and data requirements. 

Creates and prepares accompanying documents and reports.

Coordinates the implementation of clinical pilots to ensure practice commitment to program goals and deadlines. 

Monitors results of pilot programs to ensure objectives are achieved.

Responsible for the analysis, review and dissemination of network performance information, including but not limited to financial, quality, utilization/satisfaction and/or disease specific.

Develops and delivers or facilitates effective multi media communication strategies, meetings, trainings and education materials for presentations with a variety of internal and external audiences.

Serves as subject matter expert and resource for researching industry practices, sharing best practice and market surveillance information to internal and external customers.

Qualifications

Required

Bachelor's Degree

5 years of relevant experience in health plan, managed care or healthcare delivery, administration or clinical practice management.

Preferred

Knowledge of Health and Population Technology and Provider reporting. 

Knowledge of Facets Cactus, Health Information Technology and Business Objects Proven experience in planned giving

Clinical experience preferred working in a provider office or delivery system; LPN, RN, BSN.  

Certified Professional Coder CPC or Certified Coding Specialist CCS  

Project Management Professional PMP certification

Medicare and ACA Risk Adjustment experience

Proven leadership experience

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity

How Corewell Health cares for you

Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance, pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

Risk Adjustment Executive

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.