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Job Details

UnitedHealth Group

Risk Adjustment Senior Manager - Ontario, CA


Nurse Manager



Ontario, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

You will create plans outcomes related to Risk Adjustment. The Senior Manager will play an essential role in performance improvement, conceiving the approach for initiative implementation, and managing deployment of risk adjustment activities and programs.

You will direct the operations for multi-year, large-scale RAF projects. Programs may be related to business process/technology migrations, process-design, program deployment and new plans related to RAF projects. Manage the development of the RA program across all essential focus areas while specifically ensuring important metrics and timelines are met within your region.

Primary Responsibilities:

  • Be an expert on Risk Adjustment, understanding the intricacies of the CMS Medicare model to create thoughtful strategies.
  • Collaborates with the VP of Risk Adjustment to help develop a clear strategy with important performance indicators. Has a knowledge in risk adjustment to participate in Joint Operations Committees and in discussions with senior leadership teams.
  • Help analyze qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects.
  • Help in the development of ad hoc reports and presentations for risk adjustment projects.
  • Assist end-users to gather reporting requirements and analyze internal reporting tools.
  • Support and oversee outreach efforts on Risk Adjustment Education based on review of pre-selected charts coupled with data management, data analysis, and provider scorecards.
  • Propose opportunities on strategies to ensure company goals are met. Ensures early detection of major risks and interdependencies.
  • Present HCC/RAF performance results and findings to important internal leadership.
  • Participate to support the Risk Adjustment Data Validation Audits.
  • Collaborate on vendor performance in respective region, providing timely feedback, analysis and outcomes supporting goals.
  • Communicate with regional Senior Leadership Teams, including Regional Vice Presidents, CHAPs, and other team members about essential deliverables, barriers and escalation that need immediate attention.
  • Demonstrate leadership and diverse teams that oversee implementation of risk adjustment interventions.
  • Interpret data and financial metrics.
  • Direct responsibility for the oversight, hands-on participation and delivery of large-scale projects/programs.
  • Organize development of enterprise level planning and program objective setting.
  • Provide strategic input on the development of program roadmaps, action plans, work plans and timelines.
  • Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies.
  • Ensure communication between the team members, business leaders and diverse teams.
  • Maintain collaborative working relationships with Claims, Enrollment, IT, our essential collaborators, and contracted vendors.
  • Ability to influence other departments to ensure deliverables are accomplished as promised.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • 2-5 years of experience in Managed Care, Payer/Provider/Health Plan and/or Health system management.
  • 2-5 years of experience with a large medical group or IPA
  • Track record for exceeding performance results.
  • Excellent interpersonal, with the ability to engage and inspire trust across all levels of an organization.
  • Must and with a bias for and problem resolution ability to be a team player.
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Understand Risk Adjustment Factor methodology and approaches to support accurate coding.
  • Experience and fluent in revenue cycle management systems and other healthcare financial performance.
  • Experience with payers and billing including knowledge of ICD-10 coding guidelines.
  • Medical group/IPA experience, having and partnering with multiple team members and executives.

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.