Hybrid Risk Management Leader, Data-Driven Risk Adjustment

Cambia Health; Boise (ID); Hybrid; USD 111,000 - 151,000; Full time

Benefits offered by this job

Health coverage

401(k) with company match

Paid time off

Parental leave

Wellness programs

Job summary

Cambia Health in Boise is seeking a Manager, Risk Management Business Team to lead data submissions for CMS risk adjustment programs. Hybrid role with in-office presence three days per week, collaborating across IT, compliance, enrollment, claims and product teams.

The role requires a Bachelor’s degree and 10+ years of data analysis or related experience; strong project management, leadership and communication skills are essential, with focus on accuracy and process improvements.

Qualifications

• Bachelor’s degree in Business, Data Analysis or other related field.
• 10 years of data analysis, process modeling or equivalent education/experience.
• Strong analytical, problem-solving and communication skills.

Responsibilities

• Corroborates with IT, compliance, legal and other teams to maximize submission measurements.
• Oversees RADV audits and ensures timely data submission; prepares executive reports.
• Develops medical underwriting rules reflecting rating strategy to drive revenue targets.
• Directs projects and defines performance criteria and objectives.
• Ensures day-to-day operations are supported by the Risk Management team; identifies issues and resolves them.
• Develops and reviews policies, processes and practices for coordination with the team.
• Develops, implements and monitors audit processes for Edge Server usage.
• Responsible for training materials and delivery.
• Interacts with IT to resolve data submission issues and supports staff development and retention.

Skills

Analytical thinking

Communication skills

Leadership

Project management

Collaboration

AI tools

Education

Bachelor's degree in Business, Data Analysis or related field

Tools

Edge Server

Job description

Cambia Health in Boise is seeking a Manager, Risk Management Business Team to lead data submissions for CMS risk adjustment programs. Hybrid role with in-office presence three days per week, collaborating across IT, compliance, enrollment, claims and product teams.

The role requires a Bachelor’s degree and 10+ years of data analysis or related experience; strong project management, leadership and communication skills are essential, with focus on accuracy and process improvements.