Risk Adjustment Specialist (Clinical)

PA Health & Wellness; Pennsylvania; On-site; USD 55,000 - 99,000; Full time

Job summary

Join a leading healthcare organization as a Risk Adjustment Specialist where you will support key programs in Risk Adjustment for 28 million members. Your role involves training, vendor management, and operational development, ensuring efficiency in healthcare service delivery. With competitive pay and benefits, this position offers an opportunity to enhance your career in a supportive environment.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work approach

Qualifications

• Bachelor’s degree or equivalent experience required.
• 2 years of quality improvement or clinical experience needed.
• Experience in managed care preferred.

Responsibilities

• Support development and maintenance of Risk Adjustment programs.
• Train providers and staff in Risk Adjustment methodologies.
• Research best practices for Risk Adjustment operations.

Skills

Risk adjustment

Microsoft Excel

Quality improvement

Education

Bachelor's degree

Job description

Join to apply for the Risk Adjustment Specialist (Clinical) role at PA Health & Wellness

Join to apply for the Risk Adjustment Specialist (Clinical) role at PA Health & Wellness

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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

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Hospitals and Health Care and Insurance

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