Risk Adjustment Specialist (Clinical)

Position Purpose: Support the development and maintenance of Risk Adjustment related programs and reporting. Aid in working with Risk Adjustment vendors for programs within all lines of business.

Key Details: RN License, Clinical and/or Quality Improvement and HEDIS experience is required. Candidates are not required to live in PA but will be required to work EST.

• Aid in the development and support of company-wide Risk Adjustment initiatives within all product lines and assist in vendor management related to those initiatives

• Help train providers and Health Plan staff in Risk Adjustment methodologies and activities to continue to improve Centene’s Risk Adjustment score – some travel maybe required

• Research and assist in development of best practices into operations for Risk Adjustment

• Prepare operational workflows specific to each product business requirements and the local market dynamics

• Prepare and participate in meetings with various committees and providers
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor’s degree or equivalent experience. 2 years of quality improvement or clinical experience required. Bachelor’s degree in nursing and experience in managed care industry preferred.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act