Manager, Risk Adjustment

Centene Corporation; Arizona; Híbrido; USD 88.000 - 158.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/hybrid/work schedules

Descripción de la vacante

Centene Corp. is seeking a Risk Adjustment & Quality Improvement lead to manage business processes for assigned products and plans.

You will collaborate across departments to implement requirements, develop workflows, and monitor risk adjustment strategies while supporting health plan initiatives. The role is remote with preferred AZ location and periodic travel; you will prepare dashboards for senior management and lead a team of 7 in AZ/NV, requiring strong analytical and leadership

Formación

• Bachelor's degree or equivalent in a related field.
• 4+ years of project management, operations, quality improvement or data analysis in healthcare.
• Managed care or Medicare experience is preferred.

Responsabilidades

• Develop and implement action plans across departments for assigned products.
• Partner with departments to implement business requirements for products.
• Design and run operational workflows aligned with product needs and market dynamics.
• Evaluate and manage risk adjustment strategies across functions.
• Support health plan initiatives related to assigned products.
• Prepare dashboards for senior management and identify improvement opportunities.

Conocimientos

Analytical skills

Multi-tasking

RA programming knowledge

Presentation & leadership

Educación

Bachelor's degree

Descripción del empleo

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

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.

Centene offers a comprehensive benefits package including:

• 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