Manager, Risk Adjustment

🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

👻 Ghost score 0%

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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

• Manage business processes related to risk adjustment and quality improvement across assigned products and plans • Develop and implement action plans across departments to address business-unit issues • Create detailed workplans, issue logs and progress reports • Identify and partner with departments to implement business requirements for assigned products • Develop and execute operational workflows tailored to product requirements, competitive landscapes and local market dynamics • Evaluate and manage risk adjustment strategy across functional areas impacting assigned products • Identify and support health plan initiatives related to assigned products • Prepare dashboards for senior management and identify improvement opportunities • Lead a team of 7 direct reports in AZ and NV

🎯 Requirements

• One of the following certifications required at time of hire: CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, RHIT, RHIA or CPMA • CRC required within the first year of employment • CPMA preferred on the second year of employment • Ability to lead a team of 7 direct reports in AZ and NV • Strong analytical skills • Ability to multitask and pivot • Strong understanding of coding and risk adjustment programming • Strong presentation skills with leadership and provider network • Bachelor’s degree in related field or equivalent experience • 4+ years of project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry • Previous managed care or Medicare experience preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • 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 • Equal opportunity and diversity commitment

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