Remote Risk Adjustment & Quality Improvement Manager

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

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.