Job Summary

Remote work for this position may be approved based on policy and business considerations. Some states are not eligible for remote work (CA and NY).

Positioned in the Risk Adjustment Department, the Manager, Risk Adjustment Analytics will be responsible for leading the Risk Adjustment Analytics team and supporting the goals and objectives of the risk adjustment department through leading all data management, analysis and reporting. This role will manage and develop staff, develop processes to achieve business goals and objectives, and serve as a Risk Adjustment subject matter expert. The individual will also contribute to the overall strategy and vision of the department. This position requires someone who is adept at problem solving, possesses strong SQL coding skills and an ability to communicate effectively to internal and external constituents. As Manager, Risk Adjustment Analytics – your role will be critical towards the success of the Risk Adjustment department.

This position will lead the team in analyzing, forecasting and reporting key risk adjustment metrics to develop executive level dashboards and requires current knowledge of Risk Adjustment legislation and regulations to apply across the business. The role will also support leadership in identifying, developing, promoting and executing process improvement strategies and priorities to reduce redundancies, ensure maximum efficiencies, align with other Priority Health systems and processes, as well as to ensure appropriate policies and procedures exist.

Essential Functions

Manage activities of the team, including but not limited to planning, problem solving, staff development and communication. Responsible for balancing the workload of the team to optimize effectiveness. Provide leadership, planning, project coordination and management for a cost-effective team facilitating efficient operations to meet business needs. Participates in the development of strategic planning.Lead and develop current and multi-year risk adjustment strategy in a dynamic and evolving environment that can produce a high stress environment at times. Oversee data driven performance management of processes, programs and staff. Conduct operations in a planned, metric-driven approach. Continuously improve end to end operations/process.Accountable for ensuring ongoing key performance indicators (KPIs) measure productivity, quality and overall impact of the company’s risk adjustment program, including reporting KPIs on a weekly/monthly/quarterly/annual basis. Maintains Risk Adjustment performance management reporting and dashboards. Effectively track and monitor programs. Partner with clinical and financial analytics teams to define opportunities and areas of focus to optimize risk adjustment performance across all products. Must be able to effectively communicate across all levels while conveying current performance against goals and objectives.Expert on risk adjustment models; maintains current view of risk adjustment regulatory changes and product-specific risk model changes; ensures appropriate operational response to regulatory and risk adjustment program changes. Responsible for documenting workflow process, standard operating policies and procedures and establishing robust monitoring programs that ensures performance metrics are achieved in compliance with CMS/HHS regulations.Internal stakeholder management: ensures open communication and collaboration across all relevant internal departments/positions that intersect with Risk Adjustment (Quality, Provider Relations, Product teams, etc.). Works collaboratively with other RA leaders to assist other teams as necessary (e.g. root cause analysis) and provides feedback and shares findings on the analysis to leaders.Administrative: Ensure team members have appropriate skill sets related to their individual roles and assess performance issues and coach/mentor for improvement. Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations. Communicate Risk Adjustment program to internal and external so they understand program objectives, goals, benefits, risks, regulations, requirements for risk adjustment. Responsible for the development of actionable training materials, onboarding materials, reporting metrics, including scorecards for both internal and external stakeholders.Implement data quality controls to include reasonable checks and validations of data and reporting to ensure accuracy of outputs. Interpret data and write insights to explain performance and assist in decision making. Present data to different audiences and maintain existing views of data presentation as well as develop improved reporting and views.

Qualifications

Required

Bachelor's Degree Applied Mathematics, Healthcare Administration, Finance, IT7 years of relevant experience in data analysis and reporting, preferably as a business analyst in the health insurance industry5 years of relevant experience in Risk Adjustment Analytical role

Preferred

2 years of relevant experience in a Supervisor/Manager rolePrevious experience with EPIC

Physical Demands

Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbsWaist to Waist > 5 lbs: Seldom up to 10 lbsWaist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbsWaist to Overhead > 5 lbs: Seldom up to 10 lbsBilateral Carry > 5 lbs: Seldom up to 10 lbsUnilateral Carry > 5 lbs: Seldom up to 10 lbsPushing Force > 5 lbs: Seldom up to 10 lbsPulling Force > 5 lbs: Seldom up to 10 lbsSitting: FrequentlyStanding: OccasionallyWalking: OccasionallyForward Bend - Standing: SeldomForward Bend - Sitting: OccasionallyTrunk Rotation - Standing: SeldomTrunk Rotation - Sitting: OccasionallyReach - Above Shoulder: SeldomReach - at Shoulder or Below: SeldomHandling: OccasionallyForceful Grip > 5 lbs: SeldomForceful Pinch > 2 lbs: SeldomFinger/Hand Dexterity: Frequently

How Corewell Health cares for you

Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance, pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

Risk Adjustment Executive

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.