Remote Risk Adjustment Leader, Provider Partnerships

Praxy; Northern (KY); Hybrid; USD 96,000 - 126,000; Full time

Benefits offered by this job

Unlimited vacation

Performance bonuses

Sales commissions

Job summary

Oscar Health is hiring a Manager, Risk Adjustment, Provider Partnerships to lead the RA strategy and execution across cross-functional teams including Network, Market, Data Science, and provider partners. The role owns performance management, provider engagement, and improving documentation and coding outcomes, reporting to the Director of Risk Adjustment Prospective and Planning.

It is fully remote in the U.S. with some travel.

Qualifications

• 4+ years of relevant experience in program management, strategic planning, provider partnerships, health-plan operations, risk adjustment, contracting, or a related field.
• Demonstrated experience leading complex, cross-functional programs from planning through implementation and ongoing performance management.
• Experience using quantitative and qualitative data to identify opportunities, recommend actions, and communicate conclusions to varied stakeholder audiences.
• Strong stakeholder-management, communication, and problem-solving skills, including experience navigating external partner relationships.
• Risk adjustment experience in a health plan, provider organization, health system, or consulting environment.
• Experience with provider contracting, value-based care, provider performance programs, or provider engagement models.
• SQL/BigQuery or comparable analytical-tool experience.
• Lean/Six Sigma, or similar process improvement experience.

Responsibilities

• Lead the end-to-end strategy, implementation, and ongoing management of the Risk Adjustment Provider Partnerships program, including program plans, milestones, operating rhythms, risks, and success metrics.
• Partner with Network, Market, Legal/Contracting, Risk Adjustment, and Data Science teams to incorporate risk-adjustment requirements and enablement approaches into provider agreements and operating models.
• Establish and maintain operational relationships with provider organizations; drive alignment on performance expectations, improvement opportunities, and mutual commitments.
• Analyze provider performance, workflows, and documentation/coding trends to identify causes, prioritize opportunities, and develop targeted mitigation and improvement plans.
• Lead cross-functional implementation of provider-specific interventions; manage dependencies, resolve issues, and escalate decisions or risks that threaten outcomes or timelines.
• Develop and communicate performance reporting, program insights, risks, and recommendations to internal leaders and external partners.
• Build scalable provider education, engagement, and incentive approaches that improve adoption of risk-adjustment best practices.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Skills

Program management

Cross-functional leadership

Data analysis

Stakeholder management

Risk adjustment experience

Contracting experience

SQL/BigQuery

Lean/Six Sigma

Job description

Oscar Health is hiring a Manager, Risk Adjustment, Provider Partnerships to lead the RA strategy and execution across cross-functional teams including Network, Market, Data Science, and provider partners. The role owns performance management, provider engagement, and improving documentation and coding outcomes, reporting to the Director of Risk Adjustment Prospective and Planning.

It is fully remote in the U.S. with some travel.