Risk Adjustment Program Manager
New York, NY (Hybrid) | $125,000 to $145,000
A leading not-for-profit health plan is seeking a Risk Adjustment Program Manager to support risk adjustment initiatives across Medicare, Medicaid, and Exchange populations.
Hybrid:  2 days a week in the NYC office and 3 days a week remote.  This could possibly become 100% remote in the future. 
Responsibilities:

• Ensure accuracy of encounter submissions and resolve data discrepancies
• Identify and close risk score gaps through data analysis and provider collaboration
• Analyze program performance and refine risk adjustment strategies
• Oversee reporting, analytics, and vendor performance
• Ensure compliance with CMS and state regulations
• Lead projects, including RFPs and vendor implementations
• Supervise and mentor analysts

Qualifications:

• Bachelor’s degree required (Master’s preferred)
• 6+ years healthcare experience, including 3+ years in Risk Adjustment
• Knowledge of risk models (CMS-HCC, HHS-HCC, 3M CRG)
• Strong analytical skills (SQL or similar preferred)
• Experience in health plan, provider, or vendor environment

This is a high-visibility, strategic role offering growth and the opportunity to make a meaningful impact within a mission-driven organization.