Senior Manager, Quality Risk Adjustment – Health Plan/MCO Experienced

CareSource

Senior Manager overseeing Quality Risk Adjustment Medical Record Review at CareSource. Managing team, vendors, and optimizing risk adjustment processes using AI technologies

Posted 4/16/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $113,000 - $197,700 per yearWebsite

About the role

Key responsibilities & impact

Oversee the Quality Risk Adjustment (QRA) Medical Record Review (MRR) program
Lead and manage the MRR Team, providing guidance, training, and support
Develop and implement strategic plans to optimize risk adjustment processes
Manage outsourced vendors to execute operational production plan goals
Establish and maintain MRR quality assurance protocols
Conduct regular audits and assessments of MRR team’s work
Research technological solutions such as AI and NLP for data collection
Collaborate with Data Science, Sourcing, IT, and other stakeholders
Identify opportunities for process improvements
Monitor key performance indicators related to risk adjustment and quality metrics.

Requirements

What you’ll need

Bachelor's degree in Health Administration, Healthcare Management, or a related field is required
Master's degree is preferred
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
Two (2) years experience with implementation and/or development of AI solutions in a healthcare setting 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
Strong data analytical and problem-solving skills
Skilled in vendor management, oversight and performance reporting.

Benefits

Comp & perks

Comprehensive total rewards package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

risk adjustmentmedical record reviewmedical codingquality managementICD-10 codingHCC risk adjustment modelsCMS regulatory guidelinesAI solutionsdata analysisvendor management

Soft Skills

leadershipguidancetrainingsupportcollaborationproblem-solvingprocess improvementanalytical skills