About The Role

Reporting to the Chief Population Health Officer, the Vice President of Quality and Risk Adjustment will be a pivotal leader in overseeing and enhancing the clinical quality programs while optimizing risk adjustment initiatives for FQHCs. By collaborating closely with internal and external teams, they will implement evidence-based practices, quality benchmarks, and performance measures to enhance outcomes while ensuring a patient-centric approach. The Vice President of Quality and Risk Adjustment will mentor and develop talent and place the highest priority on being collaborative and fully-engaged in the execution and delivery of work. The ideal candidate will have a deep understanding of driving value-based care initiatives, improving patient outcomes, and maximizing cost efficiencies.

At this time, Yuvo Health is not able to provide visa sponsorship or work authorization support.

What You'll Do

• Responsible for the execution and oversight of the Risk Adjustment and Quality Programs while providing leadership and participation in risk and quality meetings as an active member of the team, to discuss policy, strategy, implementation, administration, goals, progress, and improvement of the risk program.
• Promotes risk and quality programs to meet all regulatory requirements.
• Manages the data submission process and ensures that all available data is accepted and managed appropriately.
• Manages staff in the risk adjustment and quality teams.
• Implements coaching and training plans.
• Sets goals and plans for Risk Adjustment and Quality programs (In conjunction with other leaders at Yuvo Health).
• Creates planning timelines and resource requirements; works with staff and Analytics to determine dollars at risk.
• Teams up with other departments across the business to identify correct resources for each project.
• Collaborates with finance on retrospective and prospective review programs.
• Partners with compliance and finance to ensure compliance with CMS rules and regulations in order to prepare for RADV audits.
• Creates a long-term plan to use technology and other resources to provide more and better information to FQHCs.
• Responsible for education of FQHCs on all clinical aspects of risk adjustment and quality including completion of TCV forms, proper coding, evaluation and management of chronic conditions, and identification and documentation of all risk adjustable conditions both historical and existing include those not yet identified.
• Facilitates the development of tracking and monitoring mechanisms for all projects.
• Serves as SME in meetings.
• Escalates gaps in projects to direct leadership, and other senior leadership when identified.
• Responsible to comply with Medicaid and CMS regulations with respect to Risk Adjustment and Quality rules.
• Manages vendor contracts and looks for effective ways to reduce use of vendors and build internal knowledge / use internal resources.
• Contributes to risk adjustment and quality functions related to Concurrent Review, Care Management, Complaints and Grievances, Quality
• Improvement, Member Satisfaction, Community Engagement, Government Contracts, Compliance, and Provider Engagement as outlined by the senior leadership and FQHCs.
• Assists their direct leader with continuous Risk Adjustment and Quality Improvement activities.
• Provide Risk Adjustment and Quality updates to Executive Leadership on a scheduled basis.
• Perform any other duties as reasonably required by the Company.

What You'll Bring

• Leadership experience overseeing risk management, performance improvement, and quality management programs
• Proven ability to use data for quality improvement and risk mitigation
• Knowledge of coding, HCCs, risk adjustment and quality concepts, medical record review project management, encounter data management, compliance audit concepts.
• Proven track record in driving quality initiatives, process improvement and achieving measurable outcomes
• Exceptional leadership, communication, and stakeholder management skills
• Expert team builder, having built teams from the ground up
• Experience building remote first, centralized services teams
• Comfort operating in a high-growth, early-stage organization and managing the ambiguity and messiness that can come with working in this environment.
• Thrives in a collaborative, cross-functional team environment centered around diversity, acceptance, and belonging
• A culture champion for the organization and a tireless advocate for your team

We'd Love To See

• Strong problem-solving and a customer-centric focus
• Knowledge of Lean, 6 Sigma, and 5S technologies
• Highly organized with a strong attention to detail

What We Value

• Desire to learn and grow
• Bias towards action
• Team-oriented attitude, you derive joy from seeing others succeed
• Enthusiasm for, and interest in, health equity and innovation

Benefits

Base Salary Range: $180,000 - $210,000

Additionally, Yuvo is proud to offer the following:

• Unlimited vacation leave
• Paid parental leave
• Competitive medical, dental, and vision insurance
• $500 reimbursement for reasonable work equipment in the first year of employment
• Stock options