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.We have an opportunity to join the Alliance as a Risk Adjustment Program Manager in the Risk Adjustment Department. WHAT YOU'LL BE RESPONSIBLE FORReporting to the Risk Adjustment Director, this position: Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activitiesManages small- to large-scale projects that advance business outcomes to achieve strategic objectivesActs as a risk adjustment subject matter expert and resourceABOUT THE TEAMRisk 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 settingsSkilled in provider education and engagement, from material creation to meeting facilitation, as well as addressing challenges to accurate clinical documentationProven 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 forwardExcellent presentation and communications skills, delivering clear and compelling updates and training diverse audiencesStrong commitment to compliance, clinical integrity and ethical risk capture practicesMedicare and Medi-Cal experience a plusWHAT YOU'LL NEED TO BE SUCCESSFULTo read the full position description, and list of requirements click here. Knowledge of:Research, analysis, and reporting methodsPrinciples and practices of risk adjustment program managementHealthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider typesApplication and utilization of data and analytics to drive critical financial decisionsPrinciples 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 tacticsAct as a subject matter expert and provide guidance regarding the most complex risk adjustment activities to all levels of staff across the organizationManage the development and implementation of projects, systems, programs, policies, procedures, and workflowsManage multiple projects simultaneously, organize work, and achieve goals and timelinesProvide leadership and facilitate meetingsEducation 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 qualifyingOTHER INFORMATIONWe 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 areaTypical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka areaZone 1 (Monterey, San Benito and Santa Cruz)$110,160—$176,259 USDZone 2 (Mariposa and Merced)$100,246—$160,410 USDOUR BENEFITSMedical, Dental and Vision PlansAmple Paid Time Off12 Paid Holidays per year401(a) Retirement Plan457 Deferred Compensation PlanRobust Health and Wellness ProgramOnsite EV Charging StationsAnd many moreABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employerJoin us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Salary : $110,160 - $176,260