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Central California Alliance for Health · 20 hours ago

Risk Adjustment Program Manager (Defined Term)

California, United States

Full-time

Hybrid

Senior Level, Lead/Staff

$100K/yr - $176K/yr

8+ years exp

Central California Alliance for Health is seeking a Risk Adjustment Program Manager in the Risk Adjustment Department. This role involves developing and managing risk adjustment programs, overseeing departmental activities, and acting as a subject matter expert to enhance business outcomes.

GovernmentHealth CareHealth InsuranceHospital

Responsibilities

Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activities

Manages small- to large-scale projects that advance business outcomes to achieve strategic objectives

Acts as a risk adjustment subject matter expert and resource

Qualification

Risk adjustment program managementHealthcare industry knowledgeData analysisProvider educationEngagementProject managementSelf-directedProactiveComplianceEthical practicesMedicareMedi-Cal experienceCommunication skillsLeadership abilities

Required

Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activities

Manages small- to large-scale projects that advance business outcomes to achieve strategic objectives

Acts as a risk adjustment subject matter expert and resource

Strength in building, scaling, and managing risk adjustment programs within healthcare settings

Skilled in provider education and engagement, from material creation to meeting facilitation, as well as addressing challenges to accurate clinical documentation

Proven ability to build strong partnerships with internal stakeholders across clinical, operational and technical teams to achieve shared goals

Self-directed and proactive, with the ability to manage priorities and drive projects forward

Excellent presentation and communications skills, delivering clear and compelling updates and training diverse audiences

Strong commitment to compliance, clinical integrity and ethical risk capture practices

Knowledge of research, analysis, and reporting methods

Knowledge of principles and practices of risk adjustment program management

Knowledge of healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types

Knowledge of application and utilization of data and analytics to drive critical financial decisions

Knowledge of principles and practices of project management

Ability to analyze and evaluate data and trends and apply the results to the development of risk adjustment strategies and tactics

Ability to act as a subject matter expert and provide guidance regarding the most complex risk adjustment activities to all levels of staff across the organization

Ability to manage the development and implementation of projects, systems, programs, policies, procedures, and workflows

Ability to manage multiple projects simultaneously, organize work, and achieve goals and timelines

Ability to provide leadership and facilitate meetings

Bachelor's Degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a related field

A minimum of eight years of progressively responsible experience in healthcare finance or analytics, which included a minimum of three years of experience managing or supporting risk adjustment programs (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying