Pennsylvania Licensed Risk Adjustment Specialist

Job Summary

To support the development and maintenance of Risk Adjustment programs, the full-time Pennsylvania Licensed Risk Adjustment Specialist will manage vendor relationships, train healthcare providers, and assist in the implementation of best practices while working remotely on Eastern Standard Time.

Key responsibilities

• Aid in the development and support of company-wide Risk Adjustment initiatives across all product lines
• Train providers and Health Plan staff in Risk Adjustment methodologies to enhance performance metrics
• Research and develop operational workflows and best practices tailored to local market dynamics

Required qualifications

• Bachelor's degree or equivalent experience
• 2 years of quality improvement or clinical experience required
• RN License is mandatory
• Experience in managed care industry preferred
• Clinical and/or Quality Improvement and HEDIS experience is required