Strategic Risk Adjustment Manager (Hybrid)

CareFirst, Inc.; Reston (VA); Hybrid; USD 105,000 - 195,000; Full time

Benefits offered by this job

Health benefits

401k retirement plan

Hybrid work model

Job summary

CareFirst, Inc. in Reston, VA is seeking a Risk Adjustment Manager to lead prospective risk adjustment strategy across Medicare Advantage, Medicaid and ACA markets. The role focuses on performance, governance, and provider engagement while guiding cross-functional teams.

Hybrid work with some days at CareFirst locations; responsibilities include regulatory alignment, financial forecasting, and strategic planning in collaboration with internal and external stakeholders.

Qualifications

• Bachelor's degree required; 4+ years additional experience in lieu of degree accepted
• 5 years progressive responsibility in a healthcare payor environment
• 1 year supervisory or leadership experience in Government Programs and Risk Adjustment
• Masters degrees preferred: MBA, MHA or related population health field

Responsibilities

• Lead development and execution of prospective risk adjustment strategies across all lines of business
• Develop provider engagement strategies, incentive programs, and training campaigns
• Assess regulatory changes and develop compliant strategies for forecasting, filings and planning
• Act as a liaison between business units and risk adjustment group to ensure collaboration and reporting

Skills

Leadership

Project management

Healthcare payor domain

Data analytics

Regulatory knowledge

Communication

Education

Bachelor's Degree

MBA / MHA / MPH (preferred)

Job description

CareFirst, Inc. in Reston, VA is seeking a Risk Adjustment Manager to lead prospective risk adjustment strategy across Medicare Advantage, Medicaid and ACA markets. The role focuses on performance, governance, and provider engagement while guiding cross-functional teams.

Hybrid work with some days at CareFirst locations; responsibilities include regulatory alignment, financial forecasting, and strategic planning in collaboration with internal and external stakeholders.