HEDIS Risk Adjustment Specialist (Clinical)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

*****NOTE: This fully remote role is open to applicants who are willing to work a central time zone schedule, Monday through Friday 8-5 pm CT. Preference will be given to applicants with either an RN or LPN licensure, and either HEDIS or risk adjustment experience. ****

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.

• 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

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.

****Additional Details:
• Department: MED-Quality Improvement
• Team Focus: HEDIS Risk Adjustment ***** 

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.  Total compensation may also include additional forms of incentives.

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