Manager, Risk Adjustment Vendor & Performance Management

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Develop and spearhead the risk adjustment vendor strategy that aligns with enterprise objectives.

• Assess vendor requirements, source and evaluate potential partners, and establish success metrics.

• Negotiate contracts while managing day-to-day vendor relationships.

• Oversee RFPs, vendor selection processes, implementation, and offboarding procedures.

• Handle onboarding and wind-down activities, including data retention and destruction protocols.

• Ensure a seamless transition and integration of vendor services.

• Design and uphold KPI frameworks for both vendors and internal operations.

• Develop models and reporting mechanisms to assess financial impacts and operational outcomes.

• Analyze performance trends to uncover opportunities for improvement.

• Conduct audits of internal and vendor reporting for accuracy and completeness.

• Guarantee data integrity and compliance with measurement standards.

• Support adherence to compliance and internal control requirements.

• Monitor vendor expenditures, billing, and budget performance.

• Create forecasts and provide financial insights to leadership.

• Advise on budgetary risks and strategies for mitigation.

• Review and reconcile vendor invoices to ensure they are accurate and paid promptly.

• Collaborate with enterprise leaders to establish targets and identify corrective actions.

• Present insights and recommendations to executive stakeholders.

• Mentor and guide analytics and reporting teams.

⛳️ Requirements

• Bachelor’s degree in business, finance, statistics, healthcare, or a related field is preferred.

• A minimum of 6 years of experience in healthcare or insurance with a focus on analytics and reporting.

• At least 3 years of supervisory experience.

• In-depth knowledge of risk adjustment and vendor performance management.

• Strong analytical and statistical modeling capabilities.

• Proven experience in developing KPIs and performance frameworks.

• Advanced proficiency in Excel.

• Experience with SAS, R, or SQL is preferred.

• Familiarity with ACA, Medicare, or Medicaid risk adjustment programs is a plus.

• CPA or CMA certification is preferred.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous PTO.

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.