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Risk Adjustment Program Manager
 Mass General Brigham Health Plan | |
 United States, Massachusetts, Somerville | |
| 399 Revolution Drive (Show on map) | |
 Mar 12, 2025 | |
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Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. The Program Manager leads risk adjustment-related projects from conception to implementation to ongoing operations. The Program Manager will provide thought leadership, project management, vendor management and complex analytic work to ensure the success of the assigned project. The Program Manager will develop new ideas to continually improve the success of the risk adjustment activities within our company. This role requires interacting and influencing internal and external stakeholders to ensure project success. The Program Manager will follow and document all CMS and MassHealth risk-related activities and ensure the company is positioned to meet any new requirements; as well as develop ideas that enhances our company's competitive position for risk adjustment. Principal Duties and Responsibilities: *Lead all internal and external risk adjusted projects. *Follows all CMS calls and presentations to ensure compliance and identify new ideas and strategies for improving risk adjustment. *Manages all vendor relationships and helps negotiate any new or existing contracts. *Develop and present complex analytics that communicate ongoing financial performance from internally custom built and externally vendor-built sources. *Communicate directly with C Suite as needed for risk adjustment analytics. *Participate in all audits. *Develops strategies for provider training, education, and medical management. *Evaluates data quality of internal and external datasets. *Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect. *Hold self and others accountable to meet commitments. *Ensure diversity, equity, and inclusion are integrated as a guiding principle. *Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. *Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. *Other duties as assigned with or without accommodation. Education
Experience
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Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. | |