Job Information
CenterWell Medicare Risk Adjustment Strategy Lead in Trenton, New Jersey
Become a part of our caring community and help us put health first
The Medicare Risk Adjustment Strategy Lead in the PCO risk adjustment area implements and supports strategy and targeted initiatives aimed at increasing clinical efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment. Uses data-based insight to direct process improvement efforts within the clinical and shared services community. Advises executives and market leadership to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. Identifies and anticipates industry trends and develops internal initiatives to meet the ever-evolving business needs. Stays on the cutting age of technology and third-party vendors as to support our clinical mission. Works with operational leaders to track and trend leading KPI’s to meet the company’s budgetary expectations.
Use your skills to make an impact
Required Qualifications
Bachelor’s degree in business, finance, accounting, economics, or a related field
A minimum of five years of experience in healthcare strategy or finance-related consulting, demonstrating a strong understanding of industry dynamics and financial frameworks.
Proven business and financial acumen, including experience with financial modeling and ability to interpret and analyze complex financial data
Proven ability to perform qualitative and quantitative analysis and leverage management consulting frameworks and tools (e.g., competitive analysis, strategy road map, strategic investment prioritization) to structure and solve complex business problems
Proven ability to create executive-level presentations and deliverables that effectively communicate complex concepts
Proactive, self-starter with a high level of initiative and resourcefulness
Comfortable with ambiguity and ability to effectively multi-task, time manage, and prioritize
Excellent verbal and written communication skills, with strong presentation skills and attention to detail
Collaborative team-player with strong interpersonal skills, excellent emotional intelligence, and comfortability collaborating across segments and the enterprise to drive work forward
Demonstrated progressive, expanded responsibilities with a proven track record of success
Must be passionate about contributing to an organization focused on continuously improving patient experience and outcomes
Preferred Qualifications
Master of Business Administration or related Master’s degree
Prior experience within healthcare services or care delivery organizations
Prior knowledge of Value Based Care organizations, specifically around clinical operations and/or Risk Adjustment
Experience in SQL and/or Power Platform
Experience working in a highly matrixed organization
Additional
Remote role
Occasional travel, 25% to various CenterWell and Conviva markets or team on-sites
Work at Home Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 05-30-2025
About us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources