Develops, coordinates and implements the strategic direction of the CMD program as it relates to the education for Advocate Aurora Health and Advocate Physician Partners
Provides education, consultation and direction to the providers and all levels of the organization as it relates to managing clinical risk
Develops, standardizes, maintains and implements risk adjustment training programs, materials, websites and workflows for all areas of the organization to achieve CMD program goals
Serves as the subject matter expert and internal primary point of contact for all Condition Management and Documentation related topics and guidance
Works with coding/coding auditors to develop workques/rules to identify CMD related focus areas for querying and missed codes and coordinate manual chart reviews of a practice to analyze clinical documentation to identify patterns and trends to develop appropriate Performance Improvement plans
Collaborates with quality, operations and providers to develop recommendations to complete PDSA/Improvement plans to drive Risk Adjustment improvement that includes creating tools and reports to meet CMD goals

5 years of experience in healthcare (payer, population health, quality, coding, managing health care clinical risk or similar industry)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or Registered Nurse license issued by the state in which the team member practices, or Certified Risk Adjustment Coder (CRC) issued by American Academy of Professional Coders (AAPC)
Bachelor's Degree in Health Information Management, or Bachelor's Degree in Nursing or related field
Medicare Advantage knowledge strong preference
Strong knowledge of ICD diagnoses coding guidelines and Medicare Risk Adjustment Payment Methodology related to HCC/RAFs
Professional experience influencing changes in behavior
Knowledge of payor plan requirements and impact to RAF scores as it relates to MSSP and Medicare Advantage programs
Knowledge of EPIC and reporting solutions
Intermediate proficiency in Word, PowerPoint, Excel, Outlook including ability to create pivot tables, formatting, sorting, create sheets with formulas (sum, vlookup)
Strong aptitude for critical thinking and demonstrated analytical and data skills

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short
and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Condition Management Consultant

Key skills