Risk Adjustment Specialist – Clinical

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

📋 Description

• Assist in the creation and upkeep of programs and reporting related to Risk Adjustment.

• Collaborate with Risk Adjustment vendors on initiatives across all business lines.

• Support the establishment and advancement of company-wide Risk Adjustment projects across all product lines.

• Contribute to vendor management concerning Risk Adjustment initiatives.

• Aid in training providers and Health Plan personnel on Risk Adjustment methods and practices.

• Conduct research and help integrate best practices into operations for Risk Adjustment.

• Develop operational workflows tailored to the requirements of each product and local market conditions.

• Organize and engage in meetings with various committees and providers.

• Carry out other responsibilities as assigned.

⛳️ Requirements

• RN License is mandatory.

• Experience in clinical settings and/or Quality Improvement and HEDIS is essential.

• While candidates are not required to reside in PA, they must work on Eastern Standard Time.

• A Bachelor’s degree or equivalent experience is necessary.

• A minimum of 2 years of experience in quality improvement or clinical roles is required.

• A Bachelor’s degree in nursing along with experience in the managed care sector is preferred.

• Some travel may be necessary.

• Adherence to all policies and standards is required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

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