Risk Adjustment Manager

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

📋 Description

• Oversee business processes pertaining to risk adjustment and quality enhancement for designated products and plans.

• Formulate and execute action plans that span various departments impacting the assigned products and plans.

• Construct comprehensive work plans, issue logs, and progress reports.

• Identify and collaborate with departments to fulfill business requirements for the assigned products.

• Design and implement operational workflows tailored to product business specifications, competitive environments, and local market conditions.

• Assess and manage the risk adjustment strategy across functional areas affecting the assigned products.

• Recognize and assist health plan initiatives associated with the assigned products.

• Generate dashboards for senior management and pinpoint opportunities for improvement.

⛳️ Requirements

• Bachelor’s degree in a relevant field or equivalent experience.

• 4+ years of experience in project management, operations, quality improvement, or data analysis/reporting within the healthcare sector.

• Preference for candidates with clinical or social work experience.

• Prior experience in managed care or Medicare is advantageous.

• Experience with MLTSS is a plus.

• The ideal candidate should reside in the state of PA.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the total compensation package.

• Benefits may be contingent upon program eligibility.