CareSource · 16 hours ago
REMOTE - Senior Manager, Quality Risk Adjustment - R11779
United States
Full-time
Remote
Mid, Senior Level
$113K/yr - $198K/yr
7+ years expCareSource is a healthcare organization that is seeking a Senior Manager for their Quality Risk Adjustment team. The role involves overseeing the Medical Record Review program, ensuring regulatory compliance, and leveraging AI technologies to enhance data accuracy and quality outcomes.
Health CareMedicalNon Profit
Responsibilities
Lead and manage the MRR Team, providing guidance, training, and support to ensure high-quality performance in medical record retrieval and coding
Develop and implement strategic plans to optimize risk adjustment processes and improve overall quality metrics for insourced and outsourced activities MRR
Manage outsourced vendors to execute to operational production plan goals and contractual requirements
Manage vendor administrative expenses including chart copying costs
Work with QRA Compliance Team to establish and maintain MRR quality assurance protocols for medical record retrieval and coding to ensure compliance with all applicable regulations and industry standards
Conduct regular audits and assessments of MRR team’s work for documentation retrieval accuracy, completeness, and efficiencies
Research technological solutions such as the use of artificial intelligence (AI), natural language processing (NLP), work flow management tools, and more to enable more efficient and accurate data collection and reporting of risk adjustment data, ensuring accuracy and timeliness
Collaborate with Data Science, Sourcing, IT, and all necessary stakeholders to deploy AI/NLP solutions
Collaborate with QRA teams, market provider relations teams, providing transparency and timely escalations as needed to ensure operational goals are achieved
Improve insourced retrieval and outsourced vendor work flows and enhance the integration of AI tools in risk adjustment initiatives
Develop and implement training programs for staff on how to most efficiently and effectively retrieve medical records, vendor management principles, and the use of AI tools
Identify opportunities for process improvements and implement initiatives to enhance operational efficiency and quality outcomes
Monitor key performance indicators (KPIs) related to risk adjustment and quality metrics, reporting findings to senior leadership
Perform any other job related duties as requested
Qualification
Required
Bachelor's degree in Health Administration, Healthcare Management, or a related field is required
Seven (7) years experience in risk adjustment medical record review program management, medical coding, or quality management in a healthcare setting required
Three (3) years of leadership experience required
Knowledge of ICD-10 Coding
Knowledge of HCC Risk Adjustment models
Knowledge of CMS regulatory guidelines
Ability to utilize AI Technologies and their applications in healthcare data management and analysis
Excellent leadership, communication and interpersonal skills
Strong data analytical and problem-solving skills
Familiarity with CMS and HHS RADV audits
Skilled in vendor management, oversight and performance reporting
Preferred
Master's degree is preferred
AAPC CPC (Certified Professional Coder), CRC (Certified Risk Adjustment Coder), AHIMA RHIT, or equivalent preferred
Benefits
You may qualify for a bonus tied to company and individual performance.
Substantial and comprehensive total rewards package.
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
H1B Sponsorship
CareSource has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (30)
2024 (39)
2023 (35)
2022 (21)
2021 (37)
2020 (28)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
Company data provided by crunchbase