Manager, Risk Adjustment

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Upward Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2010

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Series C - Upward Health on 2025-01

Healthcare • Healthcare Insurance

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Their clinical team treats physical, behavioral, and social health needs where patients need help, offering services from management of chronic conditions (e. g. , congestive heart failure) to behavioral health support and connecting patients with social services like medically tailored meals. They serve patients directly and partner with health plans and providers, emphasizing reduced emergency department visits, improved outcomes, and high patient satisfaction. Upward Health operates community-focused care teams including doctors, nurses, and community health workers, and promotes “Healthcare Comes Home” through house calls and transitions-of-care programs.

📋 Description

• Manage risk adjustment operations and oversee execution of the annual Risk Adjustment strategy to meet internal and external goals, including reporting, operational execution, and performance monitoring tied to RAF, Medicaid risk score, and acuity outcomes. • Manage and provide oversight of risk adjustment client data files, including review, prioritization, coordination, and operational use of data outputs to identify opportunities, support intervention planning, and inform risk adjustment decision-making. • Act as a risk adjustment subject matter expert for RAF, Medicaid risk score operations, performance trends, and related operational processes, including participation in internal and external meetings, health plan client communications, and cross-functional working sessions. • Oversee the use and maintenance of dashboards, reports, worklists, and performance tools that enable Quality, Clinical Operations, and Provider Network teams to improve RAF and Medicaid risk score performance. • Translate RAF, Medicaid risk score, and related performance data into clear priorities, operational actions, and recommendations for leadership and partner teams. • Partner with Clinical Operations, Clinical Excellence, Quality, and Provider Network teams to support risk adjustment performance improvement initiatives, intervention prioritization, and market-specific execution. • Support the business management of risk adjustment tools, including Navina, and help drive configuration, prioritization logic, workflow design, and adoption across operational teams. • Track performance goals, monitor outcomes, and provide regular updates and recommendations to leadership to strengthen risk adjustment, RAF, and Medicaid risk score performance across markets and partners.

🎯 Requirements

• 5+ years of progressive experience in risk adjustment, population health, value-based care, or a closely related function within a payer (preferred) or risk-bearing provider organization preferred. • Demonstrated success managing or overseeing risk adjustment or value-based performance reporting, client data file workflows, analytics, and improvement initiatives with measurable business impact. • Bachelor’s degree required; advanced degree in healthcare administration, business, public health, or related field preferred. • Experience working across clinical, operational, and provider-facing teams, with a track record of influencing stakeholders and driving accountability.

🏖️ Benefits

• Upward Health is proud to be an equal opportunity/affirmative action employer.