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Risk Adjustment Market Strategist

2 months ago

Tampa, Florida, United States Centene Corporation Full time
Job Summary

Centene Corporation is seeking a highly skilled Risk Adjustment Market Strategist to join our team. As a key member of our Risk Adjustment prospective team, you will play a critical role in developing and executing the risk adjustment prospective strategy for assigned markets.

Key Responsibilities
  • Develop and execute the risk adjustment prospective strategy for assigned markets, including building strong working relationships with market staff and leadership.
  • Collaborate with market staff and leadership to enhance quality-monitoring tools, implement process improvements, and develop training plans for market staff aimed at improving Partnership for Quality participation/completion.
  • Develop and employ process-monitoring tools to identify root cause, and provide timely reporting on productivity, audit results, and process improvement opportunities.
  • Perform data analysis and develop specific actions to manage market performance.
  • Develop and implement Partnership for Quality and In-home Assessments workflows and policies & procedures.
  • Lead and deliver training programs and updates internal and external training documents and other materials.
  • Proactively monitor appropriate metrics to improve both quality and drive efficiency.
  • Direct involvement in building collaborative relationships with other departments to resolve quality issues and barriers.
  • Drive improvement of market performance by analyzing, interpreting, and communicating risk and quality metrics.
  • Establish and lead cross-functional communication and collaboration with internal departments to support market performance and resolve barriers and challenges.
  • Plan, prepare, and execute effective group meetings/discussions with proper objectives and outcome.
  • Responsible for understanding Risk Adjustment, HEDIS, and STARS measures and partner the Quality team to drive improved provider performance.
  • Special projects as assigned or directed.
Requirements
  • 3-5 years of experience in Network Management/Network Development, Provider Relations, Risk Adjustment, Risk, and/or Value-Based Contracting.
  • Required 3+ years of experience in Healthcare or Managed Care.
  • Preferred 1+ year of experience in Leading or supervising others.
  • Preferred 3+ years of experience in Medicare/Medicaid Risk Adjustment.