Mgr, Risk Adjustment Vendor & Performance Mgmt
About The Position
This role is responsible for vendor management, performance measurement, and analytics for Enterprise Risk Adjustment. It drives strategy, ensures accurate KPI reporting, and partners cross-functionally to optimize vendor and operational performance across Commercial, Medicare, and Medicaid programs. The role develops enterprise-aligned vendor strategy; identifies, evaluates, and selects partners; negotiates contracts; and manages vendor relationships and transitions. It designs and maintains KPI frameworks, models financial and operational outcomes, analyzes performance trends, audits reporting, and supports data integrity, compliance, and internal controls. It also monitors vendor spending and billing, develops forecasts, provides financial insights to leadership, and advises on budget risks and mitigation. The position partners with enterprise leaders to define targets and corrective actions, presents recommendations to executive stakeholders, and mentors analytics and reporting teams.
Requirements
- Bachelor’s degree preferred in business, finance, statistics, healthcare, or a related field.
- At least 6 years of healthcare or insurance experience with analytics/reporting.
- At least 3 years of supervisory experience.
- Extensive knowledge of risk adjustment and vendor performance management.
- Strong analytical and statistical modeling skills.
- Experience developing KPIs and performance frameworks.
- Advanced Excel proficiency.
- Skills in vendor management, risk adjustment analytics, KPI development, financial modeling, contract negotiation, data analytics, stakeholder management, and regulatory awareness.
Nice To Haves
- CPA or CMA certification.
- Experience with SAS, R, or SQL.
- Experience in ACA, Medicare, or Medicaid risk adjustment programs.
Responsibilities
- Develop and lead risk adjustment vendor strategy aligned to enterprise goals.
- Identify vendor needs, source and evaluate partners, and define success measures.
- Negotiate contracts and manage day-to-day vendor relationships.
- Lead RFPs, vendor selection, implementation, and offboarding.
- Manage vendor onboarding and wind-down activities, including data retention and destruction.
- Ensure effective transition and integration of vendor services.
- Design and maintain KPI frameworks for vendors and internal operations.
- Develop models and reporting to measure financial impact and operational outcomes.
- Analyze performance trends and identify improvement opportunities.
- Audit internal and vendor reporting for accuracy and completeness.
- Ensure data integrity and adherence to measurement standards.
- Support compliance and internal control requirements.
- Monitor vendor spend, billing, and budget performance.
- Develop forecasts and provide financial insights to leadership.
- Advise on budget risks and mitigation strategies.
- Review and reconcile vendor invoices to ensure accurate and timely payment.
- Partner with enterprise leaders to define targets and corrective actions.
- Present insights and recommendations to executive stakeholders.
- Mentor and guide analytics and reporting teams.
Benefits
- Comprehensive health benefits, including medical, dental, and vision.
- Retirement plans.
- Generous PTO.
- Incentive plans.
- Wellness programs.
- Paid volunteer time off.
- Tuition reimbursement.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
