Risk Adjustment Program Manager (Defined Term)

This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position.

This position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones.

We have an opportunity to join the Alliance as a Risk Adjustment Program Manager in the Risk Adjustment Department.

Reporting to the Risk Adjustment Director, this position:

• Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activities
• Manages small- to large-scale projects that advance business outcomes to achieve strategic objectives
• Acts as a risk adjustment subject matter expert and resource

ABOUT THE TEAM

Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment.

THE IDEAL CANDIDATE

• Strength in building, scaling, and managing risk adjustment programs within healthcare settings
• Skilled in provider education and engagement, from material creation to meeting facilitation, as well as addressing challenges to accurate clinical documentation
• Proven ability to build strong partnerships with internal stakeholders across clinical, operational and technical teams to achieve shared goals.
• Self-directed and proactive, with the ability to manage priorities and drive projects forward
• Excellent presentation and communications skills, delivering clear and compelling updates and training diverse audiences
• Strong commitment to compliance, clinical integrity and ethical risk capture practices
• Medicare and Medi-Cal experience a plus

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirementsclick here.

• Knowledge of:




• Research, analysis, and reporting methods
• Principles and practices of risk adjustment program management
• Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
• Application and utilization of data and analytics to drive critical financial decisions
• Principles and practices of project management




• Ability to:
  
  
  
  • Analyze and evaluate data and trends and apply the results to the development of risk adjustment strategies and tactics
  • Act as a subject matter expert and provide guidance regarding the most complex risk adjustment activities to all levels of staff across the organization
  • Manage the development and implementation of projects, systems, programs, policies, procedures, and workflows
  • Manage multiple projects simultaneously, organize work, and achieve goals and timelines
  • Provide leadership and facilitate meetings
  
  
  
  
• Education and Experience:
  
  
  
  • Bachelor's Degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a related field
  • A minimum of eight years of progressively responsible experience in healthcare finance or analytics, which included a minimum of three years of experience managing or supporting risk adjustment programs (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
  
  
  
  

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area