Manager, Risk Adjustment, Provider Partnerships

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the comprehensive strategy, execution, and continuous management of the Risk Adjustment Provider Partnerships program, which includes program plans, milestones, operational rhythms, risks, and success metrics.

• Collaborate with Network, Market, Legal/Contracting, Risk Adjustment, and Data Science teams to integrate risk-adjustment requirements and enablement strategies into provider agreements and operational models.

• Establish and sustain operational relationships with provider organizations; foster alignment on performance expectations, improvement opportunities, and mutual commitments.

• Evaluate provider performance, workflows, and documentation/coding trends to determine root causes, prioritize opportunities, and formulate targeted mitigation and enhancement plans.

• Spearhead the cross-functional implementation of provider-specific interventions; manage dependencies, resolve issues, and escalate decisions or risks that may jeopardize outcomes or timelines.

• Develop and convey performance reporting, program insights, risks, and recommendations to internal leaders and external partners.

• Create scalable provider education, engagement, and incentive strategies that enhance the adoption of risk-adjustment best practices.

• Ensure adherence to all relevant laws and regulations.

• Perform additional duties as assigned.

• Report to the Director of Risk Adjustment Prospective and Planning.

⛳️ Requirements

• A minimum of 4 years of relevant experience in program management, strategic planning, provider partnerships, health-plan operations, risk adjustment, contracting, or a related discipline.

• Proven experience leading complex, cross-functional programs from inception through execution and ongoing performance oversight.

• Proficiency in utilizing both quantitative and qualitative data to identify opportunities, suggest actions, and effectively communicate findings to diverse stakeholder groups.

• Strong skills in stakeholder management, communication, and problem-solving, with experience in navigating external partner relationships.

• Compliance with all relevant laws and regulations.

• Experience with SQL/BigQuery or similar analytical tools (preferred).

• Background in risk adjustment within a health plan, provider organization, health system, or consulting environment (preferred).

• Familiarity with provider contracting, value-based care, provider performance programs, or provider engagement models (preferred).

• Lean/Six Sigma or similar process improvement experience (preferred).

🏝️ Benefits

• Employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Sales commissions.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• 401(k) plan participation.

• Life insurance.

• Disability insurance.

• Paid wellness time and reimbursements.

• Fully remote work from a home office.

• Occasional travel for team meetings and company events.