Risk Adjustment Consulting, Consultant

3 days ago

Long Beach CA United States Blue Shield of California Full time

Your Role

 

The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV) within the Risk Adjustment (Prospective Program) team.  This includes interaction within the Risk Adjustment team, with various cross-functional teams within Blue Shield, Blue Shield IPA/MG, working directly with our vendors and supporting our Risk Adjustment IHV program.  The ideal candidate possesses excellent interpersonal skills, project management skills, organizational skills, has high attention to detail, and is self-motivated. The candidate will also possess a desire to continually learn.

 

Your Work

In this role, you will:

  • Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods
  • Train lower-level analysts on how to update and apply these advanced analytic techniques.
  • Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results.
  • Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals.
  • Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products.
  • Lead the Member Incentive Program from inception to completion.
  • Support the In-Home Visit (IHV) program by working with the program lead to address various tasks needed.
  • Ability to synthesize different pieces of information, and effectively communicate that information.
  • The ability to manage projects/timelines to achieve successful outcomes.
  • Special Projects as requested.

Your Knowledge and Experience
 

  • Requires a bachelor’s degree 
  • Master’s degree preferred 
  • Requires deep knowledge of job area obtained through professional experience and advanced education
  • Requires at least 6 years of professional experience with 3 years in project management or vendor management experience
  • Requires excellent interpersonal, verbal and written communication and presentation skills
  • Requires strong interpersonal skills.  Able to collaborate with other cross-functional areas to meet objectives
  • Requires the ability to manage projects/timelines to achieve successful outcomes
  • Requires the ability to problem solve, be proactive, able to multitask and patience for working on large scale problems
  • Requires proficiency with MS Office (Excel, Word, PowerPoint and Visio)
  • Risk Adjustment professional experience preferred

 

Pay Range: 

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

 

#LI-SS8

  • Risk Adjustment Consulting, Consultant

    3 days ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role   The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV)...

  • Risk Adjustment Consulting, Consultant

    4 days ago

    Long Beach, United States Blue Shield of California Full time

    Your Role   The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV)...

  • Risk Adjustment Consulting, Consultant

    4 days ago

    Long Beach, United States Blue Shield of California Full time

    Your Role   The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV)...

  • Risk Adjustment Consulting, Consultant

    4 days ago

    Long Beach, United States Blue Shield of California Full time

    Your RoleThe Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV)...

  • Risk Adjustment Consulting, Consultant

    3 days ago

    Long Beach, United States Blue Shield of California Full time

    Your Role   The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV)...

  • Risk Adjustment Consulting, Consultant

    3 days ago

    Long Beach, United States Blue Shield of California Full time

    Your Role   The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV)...

  • Risk Engineering Consultant

    3 weeks ago

    Mesa, AZ, United States VirtualVocations Full time

    A company is looking for a Risk Engineering Consultant/Sr. Risk Engineering Consultant. Key Responsibilities Perform property/natural hazard risk assessments and risk improvement services Manage account risk portfolio and provide account-level risk engineering Provide advanced property consultative services and assist in marketing risk engineering...

  • Governance Risk Consultant

    2 weeks ago

    Newport Beach, California, United States Ledgent Technology Full time

    Job Title: Governance, Risk & Compliance (GRC) Consultant IIOur client, a leading employer in the Pacific Northwest, is seeking a skilled Governance, Risk & Compliance (GRC) Consultant II to join their team. As a key member of the Cybersecurity/IT Risk Management team, you will be responsible for supporting day-to-day needs and contributing to the...

  • Risk Adjustment Coding Specialist

    2 weeks ago

    Long Beach, California, United States Advanced Medical Manage Full time

    Job Title: Risk Adjustment CoderAt Advanced Medical Manage, we are seeking a highly skilled Risk Adjustment Coder to join our team.Job SummaryThe Risk Adjustment Coder will be responsible for ensuring accurate and compliant coding of medical records to meet Risk Adjustment guidelines. This role requires strong analytical and problem-solving skills, as well...

  • Risk Analytics Consultant

    1 week ago

    , MO, United States Wells Fargo Full time

    About this RoleWe are seeking a highly skilled Risk Analytics Consultant to join our Consumer Analytics Data and Oversight team. As a key member of our team, you will play a critical role in coordinating Audit and Exam responses for the Consumer Lending Chief Risk Officer (CRO) team.Key ResponsibilitiesDrive accountability for assigned initiatives, limit...

  • Risk Adjustment Coding Specialist

    4 days ago

    Long Beach, California, United States Advanced Medical Manage Full time

    Job Description**Job Summary**The Risk Adjustment Coding Specialist is responsible for managing and training on Risk Adjustment HCC coding to ensure effective collaboration between physicians, office staff, and health plan representatives to achieve goals.**Key Responsibilities**Review medical records to identify, collect, assess, monitor, and document...

  • Risk Governance Consultant

    4 weeks ago

    Mastic Beach, New York, United States MyCareersFuture Full time

    Job SummaryMyCareersFuture is seeking a highly skilled Digital Risk Management Specialist to join our team. As a key member of our Digital Risk & Compliance (DRC) service line, you will play a critical role in transforming the risk, regulatory, and compliance management function from a series of isolated transactions to one of strategic scope and...

  • Governance, Risk

    2 weeks ago

    Newport Beach, United States Ledgent Technology Full time

    Our client, one of the pacific northwest top employers, has engaged our firm in their search for an Governance, Risk & Compliance (GRC) Consultant II. The person in this role would be responsible for supporting the Cybersecurity/IT Risk Management team with day to day needs. Excellent opportunity for growth and to be a part of a dynamic and innovative...

  • Governance, Risk

    2 weeks ago

    newport beach, United States Ledgent Technology Full time

    Our client, one of the pacific northwest top employers, has engaged our firm in their search for an Governance, Risk & Compliance (GRC) Consultant II. The person in this role would be responsible for supporting the Cybersecurity/IT Risk Management team with day to day needs. Excellent opportunity for growth and to be a part of a dynamic and innovative...

  • Medical Informatics Analyst, Consultant

    2 months ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role The Commercial Markets Analytics team provides financial reporting and utilization/clinical analytics to Commercial employers and their Brokers/Consultants. The Medical Informatics Analyst, Consultant will report to the Senior Manager of Commercial Markets Analytics in Data & Analytics under Information Technology. In this role you will fulfill...

  • DRC Risk Manager/Consultant

    2 months ago

    Mastic Beach, United States MyCareersFuture Full time

    Roles & Responsibilities Zenith Infotech is an IT Recruitment Company in Singapore for the last 27 years. We are looing for a suitable candidate for the role of DRC Risk Manager/Consultant. Digital Risk & Compliance (DRC) professionals transform the risk, regulatory and compliance management function from a series of isolated transactions to one of...

  • Lead Consultant

    4 weeks ago

    Mastic Beach, New York, United States MyCareersFuture Full time

    Job DescriptionAbout the RoleWe are seeking a highly skilled and experienced Lead Consultant to join our team at MyCareersFuture. As a Lead Consultant, you will play a key role in leading and managing multiple large projects, working closely with clients to understand their business needs and delivering high-quality solutions.Key ResponsibilitiesLead and...

  • DRC Risk Manager/Consultant

    2 months ago

    Mastic Beach, United States MyCareersFuture Full time

    Roles & Responsibilities Digital Risk & Compliance (DRC) professionals transform the risk, regulatory and compliance management function from a series of isolated transactions to one of strategic scope and importance, encompassing all aspects of the entity, including investment, financing and operating decisions. Engagement Management Manage project...

  • Quantitative Risk Specialist

    2 weeks ago

    , MA, United States Parallel Consulting Full time

    Parallel Consulting: Model Risk Management ExpertAbout the RoleWe are seeking a seasoned Risk Manager to lead our Model Risk Management program at Parallel Consulting. This critical role will involve model validation, governance, audit, and performance monitoring to ensure the highest standards of risk management.Key ResponsibilitiesDevelop and implement...

  • Advisory Risk Oversight Consultant

    4 weeks ago

    Springfield, MA, United States MassMutual Full time

    The OpportunityAs an Advisory Risk Oversight Consultant, you will join a team that is focused on managing investment policies for the firm’s investment advisory programs, as well as related brokerage and insurance related products and services.  This role will be actively engaged in the construction and monitoring of investment policy guidelines and will...