Risk Adjustment Prospective Market Advisor - Military veterans preferred

**Risk Adjustment Prospective Market Advisor**
Category

Administrative & Operations support

Location

Tampa, Florida, US

Full-time

Job Id

1303950

Centene Corporation

JOB DESCRIPTION

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.
The RAPS Market Advisor (RMA) serves as a key point of contact and liaison between assigned markets and the Risk Adjustment prospective team. The RMA will develop and execute the risk adjustment prospective strategy for their assigned markets, including building strong working relationship; building trust, maintaining high market satisfaction and helping markets improve their risk adjustment performance. The incumbent will collaborate with market staff and leadership to enhance quality-monitoring tools, implement process improvements, and develop training plans for market staff aimed at improving Partnership for Quality participation/completion. The RMA develops and employs process-monitoring tools to identify root cause, and provides timely reporting on productivity, audit results and process improvement opportunities. Candidate Education: Preferred A Bachelor's Degree in Health Care, Business, Finance or any other field
* Essential Functions: * Become a subject matter expert on risk adjustment and risk adjustment prospective programs.
* * Owns and manages the relationship and performance of assigned markets as it relates to risk adjustment.
* * Performs data analysis and develops specific actions to manage market performance.
* * Develops and implements Partnership for Quality and In-home Assessments workflows and policies & procedures.
* * Leads and delivers training programs and updates internal and external training documents and other materials. Documents attendance & participation and then analyzes the effectiveness of the training programs by examining market performance.
* * Proactively monitors appropriate metrics to improve both quality and drive efficiency.
* * Direct involvement in building collaborative relationships with other departments to resolve quality issues and barriers, i.e Provider Network, Quality, Advocacy, Utilization Management, etc.
* * Drives improvement of market performance by analyzing, interpreting and communicating risk and quality metrics.
* * Establishes and leads cross-functional communication and collaboration with internal departments to support market performance and resolve barriers and challenges.
* * Plans, prepares, and executes effective group meetings/discussions with proper objectives and outcome.
* * Responsible for understanding Risk Adjustment, HEDIS and STARS measures and partner the Quality team to drive improved provider performance.
* * Special projects as assigned or directed.
* * Analyzes course evaluations in order to judge effectiveness of training sessions and to implement suggestion for improvements.
* * Coordinates all activities relative to the introduction and publication of new documents (i.e. SATs, workflows, decision trees, job aides, etc.) and the revision maintenance of existing documents. Ensures obsolete documents are archived appropriately.
* * Revise existing training materials and programs based on results, questionnaires, changing procedures and feedback from internal/ external customers, subject matter experts, program sponsors, etc. Additional Responsibilities: * Identifies and assesses opportunities to improve department results, communications and operating efficiencies.
* * Participates in cross-functional departmental planning sessions.
* * Ability to travel by automobile, plane or other public transportation as necessary.
* * Perform all other related duties as assigned by Manager.
Required or equivalent work experience 3-5 years in in Network Management/Network Development, Provider Relations, Risk Adjustment, Risk and /or Value Base ContractingCandidate Experience: Required 3+ years of experience in Healthcare or Managed Care
Preferred 1+ year of experience in Leading or supervising others
Preferred 3+ years of experience in Medicare/Medicaid Risk Adjustment Licenses and Certifications
Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility
Competitive pay
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and development
*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.*
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