Risk Management Lead: Data & Compliance (Hybrid)

Cambia Health; Salem (OR); Híbrido; USD 111 000 - 151 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Healthcare benefits

Retirement plan

Paid time off

Parental leave

Resumo da oferta

Cambia Health is seeking a Manager for the Risk Adjustment Business Team to lead data submission and risk-management initiatives across multiple offices. This hybrid role combines in-office collaboration with remote work to maximize efficiency and compliance with CMS rules.

You will direct audits, develop underwriting rules, and deliver measurable results by coordinating with IT, compliance, and product teams.

Qualificações

• Bachelor's degree in Business, Data Analysis or related field with 10 years' experience in data analysis, process modeling or equivalent.
• Strong analytical skills with ability to translate complex data into actionable solutions.
• Knowledge of risk adjustment systems and processes; project management experience.

Responsabilidades

• Corroborates with IT, compliance, legal, revenue management, claims and enrollment teams to maximize submission measurements.
• Oversees RADV audits, submits data timely and prepares executive reports.
• Develops medical underwriting rules reflecting rating strategy to drive revenue targets.
• Directs business projects and defines performance criteria and objectives.
• Ensures day-to-day operations are supported by the Risk Management team.

Conhecimentos

Analytical skills

Risk adjustment

Project management

Communication

Leadership

AI tools

Formação académica

Bachelor's degree

Ferramentas

Edge Server

Descrição da oferta de emprego

Cambia Health is seeking a Manager for the Risk Adjustment Business Team to lead data submission and risk-management initiatives across multiple offices. This hybrid role combines in-office collaboration with remote work to maximize efficiency and compliance with CMS rules.

You will direct audits, develop underwriting rules, and deliver measurable results by coordinating with IT, compliance, and product teams.