Risk Adjustment Specialist – Clinical

🕒 September 18

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🎲 Risk

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Support the development and maintenance of Risk Adjustment-related programs and reporting • Work with Risk Adjustment vendors for programs across all lines of business • Develop and support company-wide Risk Adjustment initiatives across all product lines • Assist in vendor management related to Risk Adjustment initiatives • Train providers and Health Plan staff in Risk Adjustment methodologies and activities • Research and incorporate best practices into Risk Adjustment operations • Prepare operational workflows for product business requirements and local market dynamics • Prepare for and participate in meetings with committees and providers • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• RN License required • Clinical and/or Quality Improvement and HEDIS experience required • Bachelor’s degree or equivalent experience • 2 years of quality improvement or clinical experience required • Bachelor’s degree in nursing and experience in managed care industry preferred • Must work EST • Some travel may be required • Comply with all policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plan • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Diversity-focused equal opportunity employer