Manager, Risk Adjustment

Centene Management Company LLC; Arizona; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements (remote/hyb

Flexible work arrangements (remote/hyb

Job summary

Centene Management Company LLC is seeking a senior professional to lead risk adjustment and quality improvement initiatives across assigned products and plans in a primarily remote role with a preference for Arizona. This position requires strong analytical abilities and leadership to drive cross-department collaboration.

You will develop action plans, monitor progress with detailed logs and reports, and partner with departments to implement product requirements while guiding RA programming and

Qualifications

• 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.

Responsibilities

• Manage risk adjustment and quality improvement processes across assigned products and plans.
• Develop and implement action plans, issue logs, and progress reports across departments.
• Identify and partner with departments to implement product business requirements.
• Develop and execute operational workflows tailored to product requirements and market dynamics.
• Evaluate and manage risk adjustment strategy across functional areas.
• Identify and support health plan initiatives for assigned products.
• Prepare dashboards for senior management and identify improvement opportunities.

Skills

Analytical skills

Leadership

Presentation skills

Multi-tasking

Adaptability

Communication

Education

Bachelor’s degree

Job description

Position Purpose

Manage the business processes related to risk adjustment and quality improvement across Centene’s for assigned products and plans.

Key Details

Remote role with preference in AZ location with occasional travel.

Develop and implement action plans, across all departments affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports.

Identify and partner with various departments to implement assigned products business requirements.

Develop and execute operational workflows specific to each product business requirements, competitive landscapes, and local market dynamics.

Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products.

Identify and support health plan initiatives related to assigned products.

Prepare dashboards for senior management and identify improvement opportunities.

Preferred Experience

Licenses and Certifications: One of the following certifications at the time of hire: CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, RHIT, RHIA or CPMA. CRC is required within the first year of employment. CPMA is preferred on the second year of employment.

Successfully be able to lead a team of 7 direct reports in AZ and NV.

Strong analytical skills.

Multi-tasking and pivoting.

Strong understanding of coding, RA programming.

Strong presenter with leadership and provider network.

Education/Experience

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.

Pay Range

$87,700.00 - $157,800.00 per year.

Company Information

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

• 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

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Should you need an accommodation, please email [e-mail].

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.