Easter Seals Jobs

Hybrid Work Schedule

• This role is hybrid which consists of reporting to our 100 Church Street, NYC office location 3 days per week.

Duties and Responsibilities

• Assume leadership role in the delivery and execution of the risk adjustment program by driving value through data driven decisions in a regulatory compliant manner.

• Lead regular meetings with internal leaders to review strategy and goals of the program and communicate performance, opportunities, budget versus actual, benchmark analysis to Healthfirst leadership.

• Manage the development and implementation of corporate performance improvement campaigns and initiatives as needed

• Collaborate and engage internal stakeholders such as Actuary, Delivery System Engagement, Information Technology, Product Management to ensure alignment across processes and work effort.

• Provide guidance and thought leadership to analysts and staff in support of all processes related to risk adjustment for Medicaid, Medicare & QHP products.

• Direct the communication of all appropriate changes in CMS and regulatory environment that impact risk scores, benchmark fluctuations and revenue implications.

Minimum Qualifications

• Bachelors degree in actuarial science, Mathematics, Statistics, Finance, or a similar field which demonstrates an affinity and talent for quantitative analysis

• Minimum ten (10) years' experience in a combination of quality, provider engagement and/risk adjustment, with at least 3 years in a senior leadership role

• Demonstrated knowledge of Center for Medicare and Medicaid Services (CMS) practices, policies, and regulations. Expert knowledge of Medicare Risk Adjustment Payment Methodology, HCC, CRG and other risk adjustment methodologies

• Excellent leadership and team management abilities with a history of developing high performing teams

• Experience with managed care software and analytics tools. Effective communication and interpersonal skills, with the ability to influence stakeholders at all levels

• Experience with strategy development, execution, planning, and management of high priority/high visibility projects related to corporate enterprise efforts

• Ability to analyze large data sets, synthesize interpretations and present results findings to internal executive stakeholders

• Prior experience managing a team

Preferred Qualifications

• ASA (Associate, Society of Actuaries) membership or on track to become one

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.