Senior Director, Risk Adjustment Market Performance

🔥 12 hours ago

🗽 New York, Missouri – Remote

🗽 New York – Remote 🏰 Missouri – Remote

💵 $134.6k - $249k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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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

• Provide executive leadership for risk adjustment performance across markets and lines of business • Serve as the primary liaison between Enterprise Risk Adjustment and market leadership • Lead market risk adjustment strategies and initiatives to achieve enterprise performance objectives • Establish and monitor targets for risk score capture, coding accuracy, documentation quality, chart retrieval, and provider performance • Identify and prioritize high-impact provider organizations and strategic partners • Build executive-level relationships with provider organizations and integrate risk adjustment priorities into value-based care and population health strategies • Direct collaboration across risk adjustment, provider engagement, quality, network management, actuarial, clinical operations, analytics, and external partners • Establish governance, accountability frameworks, and performance review processes • Develop executive reporting, dashboards, and action plans to measure results and address performance gaps • Conduct risk assessments, root-cause analyses, and targeted interventions • Advise enterprise and market leadership on provider investments, resource allocation, operating model enhancements, and best practices • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Analytics, Public Health, or related field, or equivalent experience required • 8+ years experience in healthcare operations, risk adjustment, managed care, provider performance, value-based care, analytics, clinical operations, or related healthcare field required • 3+ years management experience managing complex cross-functional initiatives and driving organizational performance required • 5+ years experience presenting operational performance, business results, and strategic recommendations to executive leadership required • Demonstrated expertise in risk adjustment operations, provider performance improvement, coding and documentation programs, healthcare analytics, and managed care required • Experience supporting multiple lines of business, including Medicaid, Medicare, Marketplace, and Commercial preferred • Experience developing governance frameworks, executive reporting, accountability models, and performance improvement strategies preferred • Knowledge of provider engagement, value-based care, population health, and healthcare reimbursement methodologies preferred • Proven ability to influence across matrixed organizations and lead enterprise-to-market performance initiatives that drive measurable results preferred • Master's Degree in Business Administration, Healthcare Administration, Public Health, Finance, or related field preferred • PMP, Lean Six Sigma, CPHQ, or related healthcare operations, performance improvement, or project management certification preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K and 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 • Diversity-focused equal opportunity employer