Project Manager/Director

Job Description
Overview

Title: Director / PM (Risk Adjustment & Quality Rating Systems Operations)

Location: Tigard, OR

Req ID: 1159148

Healthcare Support

Salary: $120,000 $140,000/yr

Job description
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.

Is Relocation Available?

Yes, regional

Is there additional variable compensation?

20% Manager Incentive Compensation

Are you open to sponsorship?

No

This position is:

Backfill

Is there a possibility to work remote?

No

Is there equity?

No

Are there flexible work hours?

No

Does this position have direct reports?

Yes

Describe how this position fits in your organization.

Reports to CFO of Trillium, OR Health Plan.

Oversees regional business in the Northwest (6 states).

Works closely with Corporate Risk Adjustment Team.

Partners with business areas that include: Provider Contracting, Vendor Procurement.

Oversees 4 direct reports; which includes 1 manager.

What are the 3-4 non-negotiable requirements on this position?

Bachelors Degree in Finance/Business or related field.

Risk Management.

Quality Experience.

Heath Care Finance.

Project Management Leadership Experience (3-4 years)

What are the nice-to-have skills?

Prior managed care/Medicare experience.

Director Level experience preferred

What is exciting about this opportunity?

Please use this section to describe team and company culture.

Growing organization.

Subsidiary of Centene, which is a Fortune 100 Fastest Growing Companies.
InstantServe is Proud to be an EOE and will consider all applications without regard to race, genetic information, sex, age, color, religion, national origin, veteran status, disability, or any other characteristic protected by law.

Applicants with disabilities that require accommodation or assistance in a position please call 267-369-1433 x 8031 or email staffing@iserveworld.com.

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Job Details
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