Risk Adjustment Strategic Partner
About The Position
The Risk Adjustment Strategic Partner serves as a liaison between provider organizations and Select Health, building relationships with provider organizations, clinic leaders, and healthcare providers. The role coordinates workstreams involving risk adjustment, HEDIS and STAR gap closure, and healthcare utilization. It is primarily remote with quarterly travel to local clinics and other in-person provider meetings as needed. The position helps providers understand population-health data, use data tools to monitor and analyze trends, and address gaps in care. It develops actionable clinic and provider opportunities and tailored programs that support value-based healthcare relationships. In collaboration with leadership, the partner creates implementation plans, assesses program effectiveness, advises executives on segment-specific strategies, and exercises independent judgment with minimal supervision. The role works with provider groups to advance performance goals, supports reporting and strategic engagements, and collaborates with internal teams and external partners. It also supports clinic interoperability and data access, coordinates resolution of clinic-plan issues, manages vendors, ensures compliance with relevant requirements, and reports monthly KPIs to Select Health leadership. The position is based in Murray, Utah, and is scheduled for 40 hours per week.
Requirements
- Proficiency in risk adjustment strategy for Medicare and ACA lines of business, including financial impact, RAF score calculations, and return on investment for engagement strategies.
- Demonstrated understanding of HEDIS and STAR measures.
- Knowledge of healthcare regulations and compliance requirements.
- Familiarity with value-based care, provider incentive programs, P4P, and quality programs.
- Demonstrated ability to manage projects and teams with a focus on achieving goals and objectives.
- Excellent communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
- Intermediate Excel skills and PowerPoint proficiency (MS Suite).
- Demonstrated ability to present to large groups and internal leadership.
- Strong analytical skills and experience with data analysis and reporting.
Nice To Haves
- Bachelor’s degree in healthcare administration, business administration, or equivalent work experience.
- Five years of experience in health plan and/or provider administration.
Responsibilities
- Work with provider groups to achieve annual goals, evaluate progress, identify emerging business needs, and conduct outreach and engagement for performance improvement.
- Develop strategies to address care gaps and provide actionable solutions for clinics and providers; monitor program and process effectiveness and make improvements.
- Design and implement reporting across the risk adjustment organization and with external partners, including the Kidney Team and Group Medicare.
- Support HQRI strategic engagements and represent risk adjustment in new member initiatives and PPO strategies.
- Foster relationships with providers and clinical leadership, internally and externally.
- Manage high-priority initiatives proactively and provide self-guided leadership.
- Explain and coach provider partners on value-based contracts, quality measures, risk adjustment strategies, and effective use of data reports.
- Lead operational strategies and collaborate with health-plan partners and Select Health team members to implement services.
- Ensure clinics have appropriate interoperability with Select Health through data transfer and EMR accessibility, and support efficient use of resources.
- Coordinate resolution of issues or concerns between clinic organizations and Select Health.
- Collaborate with internal stakeholders to identify and implement risk adjustment initiatives aligned with organizational goals.
- Ensure compliance with regulatory requirements and industry best practices related to population health management.
- Manage vendors that support risk adjustment activities.
- Report monthly KPIs to Select Health leadership for specific groups, regions, lines of business, and states.
Benefits
- A comprehensive benefits package with programs intended to support well-being across physical, mental, social, and financial dimensions.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
