Description
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
Position Purpose:
Strategic lead for Centene’s enterprise prospective risk adjustment programs across Medicare, Marketplace, and Medicaid lines of business. Responsible for the strategic direction, operational performance, and governance of prospective risk adjustment initiatives, including provider engagement, clinical documentation improvement, member assessment programs, in office assessment programs, and prospective program vendor management. Drives program effectiveness, compliance, and cross-functional collaboration to improve documentation accuracy, risk adjustment outcomes, and business performance.
Responsibilities:
- Lead enterprise prospective risk adjustment strategy, operations, and governance across all lines of business.
- Oversee IHA (In-Home Assessments) vendor strategy and performance, including vendor selection, contract negotiation, capacity planning, outreach effectiveness, visit completion, claims submission, invoice accuracy, service-level performance, and issue resolution.
- Lead IOA (In-Office Assessments) vendor oversight and program strategy, ensuring vendor programs are aligned to business priorities, provider workflows, risk adjustment goals, compliance expectations, and market needs.
- Own CoC+ (Continuity of Care Plus) program strategy and execution, including program design, provider enablement, appointment agenda adoption, performance monitoring, and cross-functional coordination with Quality, Network, and local market partners.
- Develop and execute provider education and CDI (Clinical Documentation Improvement) strategies that strengthen documentation quality, improve provider understanding of risk adjustment requirements, and support accurate and complete documentation of acuity.
- Oversee prospective program performance, including provider-facing initiatives, assessment programs, documentation improvement efforts, and vendor partnerships.
- Establish performance measures, governance processes, and accountability frameworks to support operational excellence and risk mitigation.
- Partner with market, clinical, quality, provider engagement, finance, compliance, network, claims, and technology leaders to improve program outcomes and organizational performance.
- Provide enterprise leadership and accountability for prospective program operations across lines of business, markets, vendors, provider groups, and functional partners.
- Serve as a strategic advisor to executive leadership regarding prospective risk adjustment performance, opportunities, and enterprise priorities.
- Partner closely with Procurement, Vendor Management, Finance, Claims, Compliance, Quality, local market teams, Provider Engagement, and Technology to align contracts, resources, reporting, and program priorities.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
- Bachelor's Degree in healthcare administration, business, clinical discipline, health information management, finance, analytics or related field required.
- Master's degree in a related field preferred.
- 10+ years of progressive healthcare leadership experience, including risk adjustment, provider engagement, clinical documentation improvement, quality or related healthcare operations required.
- Experience leading enterprise programs across multiple markets and lines of business (Medicare, Marketplace, Medicaid) required.
- Demonstrated success leading strategic initiatives, provider-facing programs, vendor partnerships, and cross-functional teams required.
- Experience managing vendor strategy and performance, including contract compliance, service delivery, financial reconciliation, and corrective action initiatives required.
- Strong knowledge of risk adjustment methodologies, healthcare operations, provider documentation, and regulatory requirements required.
- Proven executive leadership, communication, and stakeholder management skills required.
- Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
