Medicaid Risk Adjustment Program Lead - Hybrid

CareFirst, Inc.; Baltimore (MD); Hybrid; USD 107,000 - 212,000; Full time

Job summary

CareFirst, Inc. is seeking a senior professional to oversee Medicaid Risk Adjustment performance. This role drives analytics, monitors KPIs, and translates findings into actionable business strategies for improved risk-adjusted revenue.

The incumbent will work in a hybrid model in the greater Baltimore/Washington area, collaborating with clinical, operational, financial, analytics, and vendor stakeholders to implement improvements and enhance program effectiveness.

Qualifications

• 8 years project management or program management experience.
• Bachelor's Degree in Business Management or related field or in lieu of a Bachelor's degree, 4 additional years of relevant work experience.
• PMI PMP certification preferred.

Responsibilities

• Analyzes Medicaid Risk Adjustment performance across the line of business and identifies improvement opportunities.
• Monitors and reports on key performance indicators and communicates insights to leadership.
• Evaluates drivers of risk score model performance and recommends strategies to improve outcomes.
• Collaborates with stakeholders to investigate performance drivers and implement improvement initiatives.

Skills

Data synthesis

Executive presentations

Strategic thinking

Vendor platforms

Process improvement

Education

Bachelor's Degree in Business Management or related field

Master's Degree

Tools

Microsoft Applications

Job description

CareFirst, Inc. is seeking a senior professional to oversee Medicaid Risk Adjustment performance. This role drives analytics, monitors KPIs, and translates findings into actionable business strategies for improved risk-adjusted revenue.

The incumbent will work in a hybrid model in the greater Baltimore/Washington area, collaborating with clinical, operational, financial, analytics, and vendor stakeholders to implement improvements and enhance program effectiveness.