Manager, Risk Adjustment
Emergent Holdings

SUMMARY:

This role will support corporate goals and objectives and direct activities of functional areas, including but not limited to planning, staff development, problem solving and communications. This role will establish business unit's goals and objectives that support continuous quality improvement, manage and develop business unit staff and provide effective/efficient solutions to complex business problems. This role provides a level of oversight and leadership to business unit and leads change effectively.

Responsible to plan, organize, direct, control, and lead assigned business unit; specialize in development, planning, and leadership; operate within broad objectives to ensure optimum utilization of capital, manpower, and equipment for the assigned business unit.

RESPONSIBILITIES/TASKS:

• Responsible for managing large scale, current and multi-year plan strategy development in a dynamic and evolving environment.
• Manage and continuously improve end-to-end process model operations.
• Oversee data driven performance management of processes, programs, vendors, staff and providers. Conduct operations in a planned, metric-driven approach.
• Provide leadership, planning, project coordination and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
• Participate in the development of programs as a strategic partner that supports the company plan.
• Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations.
• Responsibility for balancing workload to optimize the effectiveness of the department.
• Implement data quality controls. Conduct reasonableness checks and validate data.
• Present data to different audiences. Look at existing views of data presentation and create improved views. Seek to understand and explain data trends by doing deeper analysis.
• Interpret data and write insights to explain performance and assist leaders in decision making.
• Continuous improvement mindset to continuously look for more efficient ways to present information, create report deliverables, etc.
• Manage activities of a department including but not limited to planning, problem solving, staff development and communication.
• Execute function/area objectives that support continuous improvement.
• Manage professional employees. Responsible for special projects and/or problem resolutions.
• Provide effective and efficient solutions to complex business problems. Provide high level oversight and leadership.

DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:

Bachelor's Degree in related field required. Master's Degree in related field considered a plus. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Seven years of progressively more responsible experience in a healthcare environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Three years of leadership experience in healthcare management required. Experience in risk adjustment implementing new risk adjustment programs for Medicare Advantage or Medicaid products preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: (Brief bullet points detailing the skills necessary for this position)

• Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
• Ability to work with and empower others on a collaborative basis to ensure success of unit team.
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
• Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.
• Ability to establish workflows, manages multiple projects, and meets necessary deadlines.
• Ability to work under general direction.
• Ability to work effectively in a team environment.
• Good analytical, organizational, planning, verbal and written communication skills.
• Strong technical business writing skills.
• Act with sense of urgency.
• Ability to know when to bring focus and attention to issues.
• Ability to appropriately package current state analysis and present to leaders/executives.
• Knowledge of impact analysis and financial risk adjustment impact analysis.
• Ability to manage multiple points of integration between internal systems and vendors.
• Strong Power Point and Excel skills.
• Database skills, including SAS, SQL and Access are strong enough to lead a team that regularly utilizes these tools.
• Extensive experience and knowledge of health insurance and risk adjustment.
• Knowledge of Medicare Advantage, CMS and HHS regulations.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards.

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

PAY RANGE:

"Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $88,600 and $148,500."

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

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