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Risk Adjustment Specialist – Clinical
Centene Corporation. Support the development and maintenance of Risk Adjustment related programs and reporting .
Posted 9/18/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $56,200 - $101,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Risk Adjustment methodologies and vendor management, with a strong background in clinical quality improvement and HEDIS. Capable of developing operational workflows and training staff to enhance Risk Adjustment initiatives across various product lines.
Highest-signal resume keywords
RN LicenseClinical ExperienceQuality ImprovementHEDIS ExperienceVendor Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Risk AdjustmentOperational WorkflowsBest Practices DevelopmentClinical Quality ImprovementTraining and Development
Soft Skills
CollaborationCommunicationProblem-Solving
Certifications & Qualifications
RN License
Industry Keywords
Managed CareHealth PlanQuality ImprovementRisk Adjustment InitiativesClinical Standards
About the role
Key responsibilities & impact- Support the development and maintenance of Risk Adjustment related programs and reporting
- Aid in working with Risk Adjustment vendors for programs within all lines of business
- Aid in the development and support of company-wide Risk Adjustment initiatives within all product lines
- Assist in vendor management related to Risk Adjustment initiatives
- Help train providers and Health Plan staff in Risk Adjustment methodologies and activities
- Research and assist in development of best practices into operations for Risk Adjustment
- Prepare operational workflows specific to each product business requirements and local market dynamics
- Prepare and participate in meetings with various committees and providers
- Perform other duties as assigned
Requirements
What you’ll need- RN License required
- Clinical and/or Quality Improvement and HEDIS experience required
- Candidates are not required to live in PA but will be required to work EST
- Bachelor’s degree or equivalent experience
- 2 years of quality improvement or clinical experience required
- Bachelor’s degree in nursing and experience in managed care industry preferred
- Some travel may be required
- Complies with all policies and standards
Benefits
Comp & perks- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
- additional forms of incentives may be included in total compensation