[Hiring] Risk Adjustment Specialist @Centene Corporation

Role Description

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 may be required.
• Research and assist in the 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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Qualifications

• 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.

Requirements

• RN License.
• Clinical and/or Quality Improvement and HEDIS experience is required.
• Candidates are not required to live in PA but will be required to work EST.

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.