Manager of Risk Adjustment (RN or LPN)

Key Components of the Clinical Risk Manager Position

• Manager will oversee staff nurses assigned to specific providers who will have direct access and interaction with the physician and office staff. The manager staff monitors access to relevant data; interact with health plan staff and supportive resources.

• Collaborates with field, internal and provider staff to facilitate member access to care/assessment, adherence to best practices, and coordination of services.

• Supports relevant member specific risk data for each assigned provider location and ensures targeted identified gaps in care are addressed in a timely and coordinated manner.

• works collaboratively with the Risk Adjustment, Quality and Network Mgmt. Team to educate and provide feedback to targeted providers.

• QCC is also a resource for correct risk adjustment diagnostic and procedural coding that meets required standards. In addition, the staff will ensure appropriate, timely submission of related risk adjustment data to the organization. In support of the program to monitor encounter data submission to the organization, QCC staff serves as a liaison and resource for the encounter data analysis analyst. The manager may be a resource to the member and provider by providing the appropriate information to facilitate resolution of issues that arise and to positively impact plan perception and member and provider satisfaction.

A. Key Job Responsibilities

i. Monitors provider group assigned involving multiple locations. ii. Ongoing training and orientation.

iii. Manager may gradually add other locations depending on the number of members. In order to maximize effectiveness, the maximum number of members/care coordinator should not exceed 2500.

B. Interfaces with key departments for reporting, technical support, data gathering processes and collection

C. Discuss and provides advice regarding Risk Reports for assigned Medical Groups and selected physicians and members.

BACKGROUND/EXPERIENCE

2+ years of experience in coding or medical record review is required.

2+ years of managerial or supervisory experience is highly preferred

Experience in risk management or risk adjustment is preferred

Experience in a field based role is helpful

Registered Nurse (RN) or Licensed Practical Nurse (LPN) is required.

EDUCATION

The minimum level of education desired for candidates in this position is a GED or High School Diploma.

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Employment Type Regular Career Band Description Management