Senior Risk Adjustment Operations & Quality Leader

Paycom; Huntington Beach (CA); Hybrid; USD 127,000 - 160,000; Full time

Job summary

Clever Care Health Plan seeks a Senior Manager to lead Medicare Advantage RAF, Stars, HEDIS, and CAHPS operations, improving quality, coding accuracy, and member experience. You will oversee daily program operations, vendor oversight, and cross-functional collaboration with clinical and analytics teams.

Responsibilities include strategy development, performance monitoring, and driving continuous improvement while aligning with organizational priorities in a hybrid Huntington Beach setting.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, or a related field.
• Five to eight years of experience in Medicare Advantage, managed care, health plan operations, quality improvement, risk adjustment, or population health.
• Minimum of three years of leadership experience managing teams, projects, or operational programs.

Responsibilities

• Lead operational execution of Medicare Stars, HEDIS, CAHPS, and Risk Adjustment programs.
• Develop annual operational workplans and performance goals that support quality and RAF objectives.
• Coordinate cross-functional implementation of initiatives across Provider Relations, Care Management, Pharmacy, Network Management, Compliance, and Operations.
• Use performance data and analytics to drive timely interventions and close quality and coding gaps.
• Identify operational barriers and implement corrective action plans to improve outcomes and efficiency.

Skills

Medicare Advantage

RAF (Risk Adjustment)

Stars

HEDIS

CAHPS

Provider engagement

Data analytics

Excel

Power BI

Leadership

Education

Bachelor's degree in Healthcare Administration/ Public Health/ Nursing/ related field

Tools

Excel

Power BI

Job description

Clever Care Health Plan seeks a Senior Manager to lead Medicare Advantage RAF, Stars, HEDIS, and CAHPS operations, improving quality, coding accuracy, and member experience. You will oversee daily program operations, vendor oversight, and cross-functional collaboration with clinical and analytics teams.

Responsibilities include strategy development, performance monitoring, and driving continuous improvement while aligning with organizational priorities in a hybrid Huntington Beach setting.