SCAN Health Plan - Project Manager - RADV
 |
 Company Overview
SCAN Health Plan is a Medicare Advantage Prescription Drug plan focused solely on the unique needs of seniors. As a not-for-profit, SCAN is dedicated to helping members meet the challenges of aging by providing personal service, expert guidance, and the benefits they need to maintain their health and independence.
Our Beginning
SCAN was founded in 1977 by a group of passionate seniors who were frustrated by their limited access to services and who wanted an organization that addressed their specific needs. These forward-thinking seniors formed the Senior Care Action Network, now known as SCAN Health Plan. The goal of the organization then was the same as it is today: to continue to find innovative ways to enhance seniors' ability to manage their health and to continue to control where and how they live. Since its inception, SCAN has provided the care needed to keep more than 50,000 seniors out of nursing homes.
Today
Today, SCAN is the fourth largest not-for-profit Medicare Advantage health plan in the United States. Headquartered in Long Beach, California, the plan has approximately 1,000 employees and serves nearly 130,000 members in California and Arizona.
SCAN also manages one of the largest and most successful Multi-Purpose Senior Service Projects (MSSP) in California. The MSSP provides community-based, long- term care and personal care coordination for low-income frail seniors. A similar program managed by SCAN, called Linkages, provides case management and community services to support independence for disabled adults.
The Future
SCAN seeks to expand its mission to improve the lives of seniors through its benefit offerings and overall expertise in senior health care. SCAN offers an innovative answer to the question of how to care for an increasing number of older Americans. By 2030, people aged 65 and older are expected to make up 20% of the population. By expanding its membership and maintaining its focus, SCAN will meet its goals and champion new ideas for successful aging.
SCAN is an Equal Opportunity Employer
M/F/D/V
|
For your privacy and protection, when applying to a job online:
Never give your social security number to a prospective employer, provide credit card or
bank account information, or perform any sort of monetary transaction.
Learn More >>
|
|
|
|
|
|
Project Manager - RADV
,
Long Beach
|
|
|
|
|
Job overview
|
|
|
SCAN Health Plan
|
|
|
|
|
Long Beach
|
|
|
|
|
|
|
Full-Time
|
|
|
|
Healthcare - Health Services
Social Services
Managed Care
|
|
|
|
Health Care
|
|
|
|
|
|
|
|
|
|
|
13-1010
|
|
|
Job Description
JOB PURPOSE:
Support the RADV and HCC Programs Team and Healthcare Informatics in activities related to RADV, HCC Programs, quality improvement, measurement, reporting and analysis.
ESSENTIAL JOB RESULTS:
Manage all aspects of RADV (Risk Adjustment Data Validation) related data collection including but not limited to abstraction, report submissions, audit activities, and adherence to CMS and internal timelines and performance goals.
Develop scope of RADV related projects, including goals, objectives, milestones, and deliverables.
Identify data sources and ensure the timely retrieval, accuracy and completeness of RADV related data.
Collaborate with other departments and staff on project implementation to maximize efficiency and teamwork.
Monitor project progress and budget and provide weekly status update to management; recommending and implementing corrective action plans as necessary.
Conduct comprehensive post-RADV and HCC Programs analyses to assess barriers, gaps, and opportunities for improvement.
Educate network providers on evidence based clinical guidelines and best practices to improve quality of care and service for members through webinars, on-site meetings, mail and electronic correspondence.
Conduct targeted member and provider outreach and education via electronic data exchange, phone calls/IVR, mailings, etc.
Maintains professional and technical knowledge by conducting research and by attending educational and technological workshops. This position requires contributions to team effort by accomplishing and sharing related results with other staff.
Contributes to team effort by accomplishing related results as needed.
|
|
Job Requirements
PREFERRED QUALIFICATIONS:
Bachelor's Degree in health care or related area, required. Master's Degree preferred.
Experience in quality improvement and project management, required.
Experience in RADV, preferred.
Good understanding of claims, encounters, and pharmacy data.
Proficient in SAS/SQL programming.
Proficient in Microsoft Office applications including project planning.
Strong verbal and written communication skills with the ability to express ideas in a clear and organized manner.
Strong organizational and time management skills to efficiently handle multiple projects with changing priorities.
CONDITIONS OF WORK:
Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
Occasional travel may be required.
|
|
|
|
|
|
|
|