Description
Position Purpose: Provides executive leadership for risk adjustment performance across markets and lines of business, serving as the key link between Enterprise Risk Adjustment and market leadership to translate strategic priorities into operational execution and measurable results. Leads cross-functional initiatives to improve coding accuracy, documentation quality, chart retrieval, provider performance, and risk score outcomes, while establishing governance, accountability, and sustainable processes that drive consistent performance. Acts as a trusted advisor to enterprise and market leaders, ensuring alignment across stakeholders and supporting scalable risk adjustment models across Medicaid, Medicare, Marketplace, and emerging lines of business.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- Serve as the primary liaison between Enterprise Risk Adjustment and market leadership, driving alignment, accountability, and execution of strategic priorities.
- Lead market risk adjustment strategies and initiatives to achieve enterprise performance objectives across lines of business.
- Establish and monitor performance targets related to risk score capture, coding accuracy, documentation quality, chart retrieval, and provider performance.
- Identify and prioritize high-impact provider organizations and strategic partners to maximize risk adjustment outcomes.
- Build and maintain executive-level relationships with provider organizations while integrating risk adjustment priorities into value-based care and population health strategies.
- Direct cross-functional collaboration across risk adjustment, provider engagement, quality, network management, actuarial, clinical operations, analytics, and external partners.
- Establish governance, accountability frameworks, and performance review processes to ensure successful execution of improvement opportunities.
- Develop executive reporting, dashboards, and action plans to measure results, address performance gaps, and drive continuous improvement.
- Conduct risk assessments, root-cause analyses, and targeted interventions to improve outcomes and mitigate performance risks.
- Advise enterprise and market leadership on provider investments, resource allocation, operating model enhancements, and best practices to strengthen performance across markets and lines of business.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Analytics, Public Health, or related field, or equivalent experience required. Master's Degree Business Administration, Healthcare Administration, Public Health, Finance, or related field preferred.
8+ years experience in healthcare operations, risk adjustment, managed care, provider performance, value-based care, analytics, clinical operations, or related healthcare field required.
3+ years management experience managing complex cross-functional initiatives and driving organizational performance required.
5+ years experience presenting operational performance, business results, and strategic recommendations to executive leadership required.
Demonstrated expertise in risk adjustment operations, provider performance improvement, coding and documentation programs, healthcare analytics, and managed care required.
Experience supporting multiple lines of business, including Medicaid, Medicare, Marketplace, and Commercial preferred.
Experience developing governance frameworks, executive reporting, accountability models, and performance improvement strategies preferred.
Knowledge of provider engagement, value-based care, population health, and healthcare reimbursement methodologies preferred.
Proven ability to influence across matrixed organizations and lead enterprise-to-market performance initiatives that drive measurable results preferred.
Licenses/Certifications: Project Management Professional (PMP) preferred or
PMP, Lean Six Sigma, CPHQ, or related healthcare operations, performance improvement, or project management certification preferred.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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
