[Hiring] Manager, Risk Adjustment @Centene Corporation

Role Description

Manage the business processes related to risk adjustment and quality improvement across Centene’s for assigned products and plans.

• Remote role with preference in AZ location with occasional travel.
• Develop and implement action plans, across all departments affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports.
• Identify and partner with various departments to implement assigned products business requirements.
• Develop and execute operational workflows specific to each product business requirements, competitive landscapes, and local market dynamics.
• Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products.
• Identify and support health plan initiatives related to assigned products.
• Prepare dashboards for senior management and identify improvement opportunities.

Qualifications

• Licenses and Certifications: One of the following certifications at the time of hire: CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, RHIT, RHIA or CPMA. CRC is required within the first year of employment. CPMA is preferred on the second year of employment.
• Successfully be able to lead a team of 7 direct reports in AZ and NV.
• Strong analytical skills.
• Multi-tasking and pivoting.
• Strong understanding of coding, RA programming.
• Strong presenter with leadership and provider network.

Requirements

• Bachelor’s degree in related field or equivalent experience.
• 4+ years of project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry.
• Previous managed care or Medicare experience preferred.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.