Manager, Risk Adjustment

PA Health & Wellness; Pennsylvania; Hybrid; USD 88,000 - 158,000; Full time

Job summary

PA Health & Wellness is seeking a qualified professional to manage risk adjustment and quality improvement initiatives across assigned products and plans. The role emphasizes cross-functional collaboration to implement business requirements and develop workflows aligned with local market dynamics.

The ideal candidate has a Bachelor’s degree with 4+ years in project management, operations, or data analysis within healthcare; clinical or social work experience is a plus.

Qualifications

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

Responsibilities

• Develop and implement action plans across departments for assigned products and plans.
• Identify and partner with departments to meet business requirements.
• Create operational workflows aligned with product requirements and market dynamics.
• Evaluate risk adjustment strategy across all functions.
• Prepare dashboards for senior management and identify improvement opportunities.

Skills

Risk adjustment

Quality improvement

Project management

Data analysis

Healthcare industry

Education

Bachelor’s degree or equivalent experience

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
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, 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