Risk Adjustment Specialist – Clinical

Job not on LinkedIn

🔥 3 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🎲 Risk

👻 Ghost score 0%

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 • Aid in working with Risk Adjustment vendors for programs within all lines of business • Aid in the development and support of company-wide Risk Adjustment initiatives within all product lines • Assist in vendor management related to Risk Adjustment initiatives • Help train providers and Health Plan staff in Risk Adjustment methodologies and activities • Research and assist in development of best practices into operations for Risk Adjustment • Prepare operational workflows specific to each product business requirements and local market dynamics • Prepare and participate in meetings with various committees and providers • Perform other duties as assigned

🎯 Requirements

• RN License required • Clinical and/or Quality Improvement and HEDIS experience required • Candidates are not required to live in PA but will be required to work EST • 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 • Some travel may be required • Complies with all policies and standards

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • a flexible approach to work with remote, hybrid, field or office work schedules • additional forms of incentives may be included in total compensation