Medicare Programs Clinical Lead

Leads clinical operations of Medicare programs with a primary focus in model of care development and delivery, healthcare effectiveness data and information set (HEDIS), Medicare star rating, Chronic Care Improvement (CCIP) and risk adjustment. Works closely with Sanford leadership and provider groups to ensure the model of care is carried out to members consistently and meets regulatory requirements. Assumes the role as subject matter expert on the model of care and super trainer on the delivery of that model of care to plan providers and provider groups. Develops, implements, and maintains a CCIP and Quality Improvement Projects (QIP). Participates in the quality improvement committee(s) established as a result of participation in Medicare programs. Completes gap assessment of healthcare effectiveness data and HEDIS measures and ensures providers are equipped to close remaining HEDIS gaps. Monitors star ratings and formulates action plans to achieve a four star or above rating.