Risk Adjustment Business Development Manager

Elevance Health•Tampa, FL

8d•Hybrid

About The Position

Responsible for leading the development of new business plans/strategies for Government Business Risk Adjustment initiatives. Responsibilities will include Medicaid specific risk adjustment and specialty revenue assignments; Medicare Advantage [Duals] vendor interaction; risk adjustment program enhancement; and all Revenue initiatives.

Requirements

Requires a BA/BS degree and a minimum of 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Medicaid and Medicare Experience is a must have
Healthcare Risk Adjustment experience strongly preferred
Vendor Management experience preferred
Strong communication skills with various levels of organization preferred

Responsibilities

Medicaid Risk methodology letters
Rate Cell Methodology letters
Risk adjustment scores analysis and scores documentation accuracy
state specific CDPS models
creation of advanced programs to address risk score accuracy
competitor intelligence
Leads the analysis of current and projected product lines to determine optimal business strategy
Oversees research, analysis and the development of recommendations on the external environment as part of the development of strategic business plans
Analyzes major competitor strategies.
Identifies and monitors changing patterns of competition and recommends response
Acquires and maintains data/information on market, industry, economic, consumer and competitive conditions and trends pertaining to health insurance/managed care and related services
Consolidates data, analyses and recommendations into concise business plans
Develops and implements project plans and oversees project resources
Leads the activities of lower level staff performing related functions