Risk Adjustment Specialist

5 days ago

Santa Ana, United States Optum Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Consulting HCA will be responsible for driving field based strategies in collaboration with Market Consultation leadership.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Serve as the Relationship Owner and Strategic Partner for key markets/provider groups in collaboration with Market Leadership
  • Provide guidance and consultative feedback to groups, MSOs and IPAs to drive provider engagement and adoption of Optum program and provide recommendations for improvement (Strategy Meetings)
  • Partner with business owners to identify methods to execute on key goals and initiatives
  • Effectively manage In Office Assessment Program
  • Ability to review risk adjustment key performance data (Prevalence, RAF, recapture, etc.) to assist in development of programs and initiatives for risk accuracy
  • Collaborate and coordinate with stakeholders and project teams
  • Deliver effective presentations with targeted audiences that include senior leadership with groups and MSOs
  • Provide program progress and updates to leadership
  • Work in collaboration with team coders to execute education at provider level
  • Work with senior leaders to continue to drive progress and performance
  • Provide guidance to team members in driving provider engagement and adoption of Optum program and provide recommendations for improvement
  • Work with the business to develop program success metrics and ongoing performance metrics 
  • Provides solid leadership and judgment; effectively build and deepen relationships across business 
  • Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost
  • Ability to travel 70% of time throughout the region, mostly day trips

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • 5+ years of experience in working in healthcare
  • Proven solid understanding and experience working risk adjustment, preferably within the capitated model
  • Proven solid ability to analyze and interpret data and create tactical action plan
  • Demonstrated solid communication and interpersonal skills
  • Ability to influence across complex networks of internal stakeholder
  • Able to analyze data to drive results, problem solving, strategic thinking
  • Demonstrated ability to recommend and create a variety of training solutions based on needs
  • Demonstrated ability to influence and to drive projects without formal authority 
  • Ability to travel 70% of time throughout Northern CA, including the San Fransico Area

Preferred Qualifications:

  • CPC, CRC, or other coding certification
  • Risk adjustment background
  • Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models 
  • Intermediate level skills in MS Access and Excel  
  • Expertise in chronic condition areas (i.e. oncology, diabetes, etc.) is of added value  

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Maryland, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.  

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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