Risk Adjustment Specialist (Clinical)

AECOM; Harrisburg (Dauphin County); On-site; USD 55,000 - 99,000; Full time

Job summary

Join a leading national organization in a role focused on transforming health through effective Risk Adjustment initiatives. You will support program development, assist in vendor management, and lead training efforts while enjoying a competitive salary and comprehensive benefits package.

Benefits

Health insurance

401K plan

Tuition reimbursement

Paid time off and holidays

Flexible work schedules

Qualifications

• 2 years of quality improvement or clinical experience required.
• Bachelor's degree in nursing preferred.
• Experience in managed care industry preferred.

Responsibilities

• Support development and maintenance of Risk Adjustment programs.
• Train providers and Health Plan staff in Risk Adjustment methodologies.
• Prepare operational workflows specific to product requirements.

Skills

Quality Improvement

Clinical Experience

Risk Adjustment

Microsoft Excel

Education

Bachelor’s degree or equivalent experience

Bachelor’s degree in nursing

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

*** Qualified candidates must reside in the state of Pennsylvania***

**Position Purpose:** Support the development and maintenance of Risk Adjustment related programs and reporting. Aid in working with Risk Adjustment vendors for programs within all lines of business.

+ Aid in the development and support of company-wide Risk Adjustment initiatives within all product lines and assist in vendor management related to those initiatives

+ Help train providers and Health Plan staff in Risk Adjustment methodologies and activities to continue to improve Centene’s Risk Adjustment score – some travel maybe required

+ Research and assist in development of best practices into operations for Risk Adjustment

+ Prepare operational workflows specific to each product business requirements and the local market dynamics

+ Prepare and participate in meetings with various committees and providers

+ Performs other duties as assigned

+ Complies with all policies and standards

**Education/Experience:** Bachelor’s degree or equivalent experience. 2 years of quality improvement or clinical experience required. Bachelor’s degree in nursing and experience in managed care industry preferred. Risk adjustment and Microsoft Excel experience preferred.

Up to 10% in-state travel required.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act