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Risk Adjustment Program Manager

2 months ago

Honolulu, Hawaii, United States HMSA Full time
Job Summary

We are seeking a highly skilled Risk Adjustment Program Manager to join our team at HMSA. As a key member of our organization, you will be responsible for leading our risk adjustment efforts and ensuring compliance with CMS requirements.

Key Responsibilities
  • Leadership and Performance Management
    • Develop and implement short-term and long-term strategies to meet risk adjustment accuracy goals and requirements.
    • Collaborate with internal and external stakeholders to review programs, processes, and data collection for improvement opportunities.
    • Manage the production of performance dashboards to monitor and report ongoing performance against targets.
    • Ensure processes and documentation support risk adjustment program requirements.
    • Provide subject matter expertise on Medicare Advantage Risk Adjustment to internal and external teams.
    • Manage necessary changes to existing systems, operations, or workflows to address new or revised CMS requirements.
    • Develop work plans and project scope to deliver business impact on high-priority issues.
    • Address identified deficiencies in current program quality and administration.
    • Direct regular organization-wide training to develop staff in other key departments as risk adjustment subject matter experts.
    • Meet with senior leadership to review progress, report key results, and program performance measures.
    • Conduct regulatory analyses and facilitate requirement development and implementation tracking.
    • Contribute to the development of business strategies for the Medicare line of business.
  • Effective Management of Staff
    • Oversee and manage workflows to ensure consistent, effective, and efficient service delivery.
    • Manage risk adjustment team members and vendors to achieve program and project goals.
    • Ensure the Medicare Programs contract meets risk adjustment requirements established by CMS.
    • Perform various employee management functions, including talent management, development, performance reviews, and salary adjustments.
  • Cross-Functional Integration and Communication
    • Act as the leader and champion of risk adjustment interventions.
    • Develop strong partnerships with key areas throughout the organization and external partners to improve risk adjustment accuracy performance.
    • Provide education and information to the HMSA community regarding Medicare Advantage risk adjustment.
  • Other Duties/Functions
    • Perform miscellaneous responsibilities and duties as assigned or directed.

About HMSA

HMSA is a leading healthcare organization dedicated to providing high-quality services to our members. We are committed to excellence and innovation in all aspects of our operations.