Risk Adjustment Consulting, Consultant

Company: Blue Shield of California
Location: Long Beach
Posted on: November 4, 2024

Job Description:

Your Role The Risk Adjustment Prospective Program team focused on transforming health care by making it more accessible, affordable and customer-centric. The Risk Adjustment Consulting, Consultant will report to the Senior Manager of Risk Adjustment. In this role you will lead the Member Incentive Program while supporting the In-Home Visit program (IHV) within the Risk Adjustment (Prospective Program) team. This includes interaction within the Risk Adjustment team, with various cross-functional teams within Blue Shield, Blue Shield IPA/MG, working directly with our vendors and supporting our Risk Adjustment IHV program. The ideal candidate possesses excellent interpersonal skills, project management skills, organizational skills, has high attention to detail, and is self-motivated. The candidate will also possess a desire to continually learn. Your Work In this role, you will:

• Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods
• Train lower-level analysts on how to update and apply these advanced analytic techniques.
• Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results.
• Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals.
• Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products.
• Lead the Member Incentive Program from inception to completion.
• Support the In-Home Visit (IHV) program by working with the program lead to address various tasks needed.
• Ability to synthesize different pieces of information, and effectively communicate that information.
• The ability to manage projects/timelines to achieve successful outcomes.
• Special Projects as requested. Your Knowledge and Experience
  • Requires a bachelor's degree
  • Master's degree preferred
  • Requires deep knowledge of job area obtained through professional experience and advanced education
  • Requires at least 6 years of professional experience with 3 years in project management or vendor management experience
  • Requires excellent interpersonal, verbal and written communication and presentation skills
  • Requires strong interpersonal skills. Able to collaborate with other cross-functional areas to meet objectives
  • Requires the ability to manage projects/timelines to achieve successful outcomes
  • Requires the ability to problem solve, be proactive, able to multitask and patience for working on large scale problems
  • Requires proficiency with MS Office (Excel, Word, PowerPoint and Visio)
  • Risk Adjustment professional experience preferred Pay Range: The pay range for this role is: $ 118800.00 to $ 178200.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

Keywords: Blue Shield of California, Chino Hills , Risk Adjustment Consulting, Consultant, Professions , Long Beach, California