Risk Adjustment Program Lead — Analytics & Strategy (Hybrid)

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

Job summary

CareFirst, Inc. in Baltimore area seeks an experienced risk adjustment program leader to drive ACA and BHP performance through analytics and strategic initiatives. You will translate operational performance into measurable business outcomes and coordinate with cross-functional teams.

Hybrid work arrangement is available; you will split time between home and CareFirst locations based on business needs, and contribute to risk adjustment revenue, forecasting accuracy and program effectiveness.

Qualifications

• Bachelor's degree or 4 additional years of relevant work experience in lieu of a Bachelor's degree.
• 8 years project management or program management experience.
• 8+ years in managing risk adjustment programs and provider incentives.
• 5+ years in value-based care for Commercial or ACA.
• 5+ Provider Engagement or Provider Enablement in Commercial or ACA.

Responsibilities

• Analyzes ACA and BHP risk adjustment performance across the line of business using reports, metrics, and financial results.
• Monitors and reports on KPIs; translates findings into actionable insights for leadership and P&L stakeholders.
• Evaluates drivers of risk adjustment performance; reviews benchmarks and recommends improvement strategies.
• Partners with cross-functional stakeholders to investigate performance drivers and support implementation of initiatives.

Skills

Project management

Data analysis

Stakeholder communication

Risk adjustment

Education

Bachelor's degree in Business Management or related field

Master's degree

PMP Certification

Job description

CareFirst, Inc. in Baltimore area seeks an experienced risk adjustment program leader to drive ACA and BHP performance through analytics and strategic initiatives. You will translate operational performance into measurable business outcomes and coordinate with cross-functional teams.

Hybrid work arrangement is available; you will split time between home and CareFirst locations based on business needs, and contribute to risk adjustment revenue, forecasting accuracy and program effectiveness.