Medicaid Risk Adjustment Program Lead (Hybrid Career)

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 107,000 - 212,000; Full time

Job summary

CareFirst BlueCross BlueShield seeks an experienced leader to oversee Medicaid Risk Adjustment performance, analytics, and improvement initiatives in a hybrid Baltimore-area model. You will drive insights from data, monitor KPIs, and partner across clinical, operational, and financial teams to optimize risk-adjusted revenue and forecasting accuracy.

The role requires strong program management experience, collaboration with state stakeholders, and the ability to translate complex results into

Qualifications

• 8+ years of project or program management experience.

Responsibilities

• Analyses Medicaid Risk Adjustment performance and identifies trends, risks, and opportunities.
• Monitors KPIs and communicates insights to leadership and stakeholders.
• Collaborates with cross-functional teams to drive improvement initiatives.
• Leads a matrix-managed team to achieve objectives.

Skills

Data analysis

Stakeholder management

Leadership

Process improvement

Communication

Education

Bachelor's Degree in Business Management or related field

4 years of additional relevant work experience in lieu of degree

Tools

Microsoft Office

Job description

CareFirst BlueCross BlueShield seeks an experienced leader to oversee Medicaid Risk Adjustment performance, analytics, and improvement initiatives in a hybrid Baltimore-area model. You will drive insights from data, monitor KPIs, and partner across clinical, operational, and financial teams to optimize risk-adjusted revenue and forecasting accuracy.

The role requires strong program management experience, collaboration with state stakeholders, and the ability to translate complex results into