Manager, Risk Adjustment Vendor & Performance Management

Job not on LinkedIn

🔥 12 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $109.6k - $149.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

👻 Ghost score 18%

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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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Develop and lead risk adjustment vendor strategy aligned to enterprise goals • Identify vendor needs, source and evaluate partners, and define success measures • Negotiate contracts and own day-to-day vendor relationships • Lead RFPs, vendor selection, implementation, and offboarding • Manage onboarding and wind-down activities including data retention and destruction • Ensure effective transition and integration of vendor services • Design and maintain KPI frameworks for vendors and internal operations • Develop models and reporting to measure financial impact and operational outcomes • Analyze performance trends and identify improvement opportunities • Audit internal and vendor reporting for accuracy and completeness • Ensure data integrity and adherence to measurement standards • Support compliance and internal control requirements • Monitor vendor spend, billing, and budget performance • Develop forecasts and provide financial insights to leadership • Advise on budget risks and mitigation strategies • Review and reconcile vendor invoices to ensure accurate and timely payment • Partner with enterprise leaders to define targets and corrective actions • Present insights and recommendations to executive stakeholders • Mentor and guide analytics and reporting teams

🎯 Requirements

• Bachelor’s degree preferred in business, finance, statistics, healthcare, or related field • 6+ years healthcare or insurance experience with analytics/reporting • 3+ years supervisory experience • Extensive knowledge of risk adjustment and vendor performance management • Strong analytical and statistical modeling skills • Experience developing KPIs and performance frameworks • Advanced Excel proficiency • Experience with SAS, R, or SQL preferred • Experience in ACA, Medicare, or Medicaid risk adjustment programs preferred • CPA or CMA certification preferred

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement