Manager, Medical Risk Adjustment Programs & Operations

Job Summary:

The Manager, Medical Risk Adjustment Programs & Operations is responsible for managing performance, activities and SLAs of outside vendors who are partnered with for risk adjustment interventions. This position is full-time, remote.

Essential Functions:

• Operates in a matrix environment influencing and managing collaborative risk adjustment initiatives with other internal functional groups
• Manages day to day operations of internal Risk Adjustment intervention efforts including staff production and quality standards
• Aids in developing strategy, program design and refinement of risk adjustment initiatives
• Develops and maintains documentation of Risk Adjustment processes
• Maintain excellent understanding of all CMS requirements and directives for Risk Adjustment to ensure processes are compliant with these requirements
• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions
• Perform any other job duties as requested

Education and Experience:

• Bachelor of Science degree in Finance, Business Administration or related field or equivalent work experience is required
• Five (5) years of experience in managed care and/or Risk Adjustment required
• Two (2)years of management/supervisory experience preferred

Competencies, Knowledge and Skills:

• Knowledgeable of Medicare/CMS regulations
• Knowledgeable of ICD-10 and CPT codes
• Effective oral, written and interpersonal communication skills
• Process improvement and process management
• Ability to manage, develop, motivate and reward professional staff
• Ability to effectively report data, analyze facts, and exercise sound business judgment when making recommendations
• Ability to analyze problems, draw conclusions, develop processes & communicate status and results
• Ability to work independently
• Critical listening and thinking skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$90,500.00 - $158,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies: