The Risk Adjustment Clinical Reviewer role supports, compiles and cultivates data and supporting medical documentation for Risk Adjustment and related Factors. Key lead in community outreach to providers and members in closing diagnosis gaps through in home assessments, or other face to face interactions with Primary or Specialty Care Physicians. Partner with Internal and External stakeholders to ensure upstream and downstream processes align in support of Case/Care Management, Utilization Manager, Health @ Home or Nursing Home Rounding Programs.
Regulatory Oversight and Quality Assurance:
Provider Engagement, Training and Support
Analysis and Use of Results
Enterprise Risk Adjustment
Job Specific Competencies:
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Neighborhood is an EOE M/F/D/V and an E-Verify Employer