Manager, Risk Adjustment

Centene Corporation•Remote-AZ, AZ

2d•$87,700 - $157,800•Remote

About The Position

Manage business processes related to risk adjustment and quality improvement for assigned products and plans at Centene. This is a remote role, with a preference for candidates located in Arizona and occasional travel. The role leads a team of seven direct reports in Arizona and Nevada and works across departments to address business issues, implement product requirements, and improve operational workflows and risk adjustment outcomes. The position requires a bachelor’s degree in a related field or equivalent experience, along with at least four years of relevant healthcare industry experience in project management, operations, quality improvement, or data analysis/reporting. Candidates must hold one of the listed coding or auditing certifications at hire and obtain a CRC within the first year. The role offers an annual pay range of $87,700 to $157,800. Centene describes its work as supporting access to healthcare and healthier lives, and offers a comprehensive benefits package.

Requirements

Bachelor’s degree in a related field or equivalent experience.
At least 4 years of project management, operations, quality improvement, or data analysis/reporting experience in the healthcare industry.
At the time of hire, hold one of the following certifications: CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, RHIT, RHIA, or CPMA.
Obtain a CRC certification within the first year of employment.
Strong analytical skills.
Ability to multitask and pivot.
Strong understanding of coding and risk adjustment programming.
Strong presentation skills with leadership and provider networks.

Nice To Haves

Previous managed care or Medicare experience.
CPMA certification is preferred in the second year of employment.
Arizona location is preferred.

Responsibilities

Develop and implement cross-departmental action plans for assigned products and plans to address issues identified by business units, including detailed workplans, issue logs, and progress reports.
Identify and partner with departments to implement business requirements for assigned products.
Develop and execute operational workflows tailored to product requirements, competitive landscapes, and local market dynamics.
Evaluate and manage risk adjustment strategy across functional areas that affect assigned products.
Identify and support health plan initiatives related to assigned products.
Prepare dashboards for senior management and identify opportunities for improvement.
Lead a team of seven direct reports in Arizona and Nevada.