Manager, Risk Adjustment

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Management Company LLC in Pennsylvania seeks a seasoned professional to manage risk adjustment and quality improvement for assigned products and plans. You will develop and implement action plans across departments, address issues identified by business units, and create workplans, issue logs, and progress reports.

You will partner with multiple teams to translate business requirements into operational workflows, evaluate the risk adjustment strategy, support health plan initiatives, and

Qualifications

• Bachelor’s degree required or equivalent experience in a related field.
• 4+ years of project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry.
• Clinical or Social work experience preferred; managed care or Medicare experience preferred; MLTSS experience is a plus.

Responsibilities

• Develop and implement action plans across departments for risk adjustment and quality initiatives.
• Prepare dashboards for senior management and identify improvement opportunities.
• Lead cross-department collaboration to execute product and program requirements.
• Evaluate and manage risk adjustment strategy across functional areas affecting assigned products.

Skills

Project management

Operations

Quality improvement

Data analysis

Healthcare industry experience

Education

Bachelor’s degree in related field

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: Ideal candidate to live in the state of PA. 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.

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. Clinical or Social work experience preferred. Previous managed care or Medicare experience preferred. MLTSS experience is plus.

Pay Range:

$87,700.00 - $157,800.00 per year

Benefits:

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and 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.

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.