Director, Risk Adjustment & Quality Rating Systems Operations

Health Net, Inc. - Tigard, OR

Position Purpose: Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans.

  • Oversee the development and implementation of action plans, across all departments and any vendor partners affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports
  • Identify and partner with various departments to implement assigned products business requirements
  • Develop end to end roadmap from regulatory compliance to strategic advantage
  • Develop and execute operational workflows specific to each product business requirements, competitive landscapes, and local market dynamics
  • Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products
  • Identify and support company wide risk adjustment and quality initiatives related to assigned products
  • Prepare dashboards for senior management and identify improvement opportunities
  • Review and ensure compliance with all federal and state regulations, guidance, and technical specifications

  • Qualifications:

    Education/Experience: Bachelor’s degree in related field. 7+ years of risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry. Previous experience in value-based revenue and quality improvement initiatives with various health insurance product(s) preferred. Previous managed care or Medicare experience preferred.

    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.

    Attention - In the recruitment process, legitimate companies never withdraw fees from candidates. If there are companies that attract interview fees, tests, ticket reservations, etc. it is better to avoid it because there are indications of fraud. If you see something suspicious please contact us: [email protected]