Manager, Risk Adjustment

Mass Health

Manager of Risk Management overseeing risk adjustment activities for Medicare Advantage health plan. Collaborating with UMass Memorial Health on strategy and compliance initiatives.

Posted 4/24/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesSeniorLead💰 $90,000 per yearWebsite

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

Oversee Mass Advantage's risk adjustment activities and strategy.
Execute Medicare risk adjustment programs to fulfill business objectives.
Manage external vendors and conduct regulatory audits and compliance.
Analyze Medicare revenue initiatives for senior products.
Coordinate risk adjustment initiatives across departments and provider partners.

Requirements

What you’ll need

Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
Registered Nurse (RN) desired.
CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.
Strong Microsoft Office skills (Word, Outlook, Excel and PP).

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Mass Health Website LinkedIn All Job Openings 1 - 10 employees ⚕️ Healthcare Insurance ☁️ SaaS Healthcare Insurance
SaaS Mass Health is a company specializing in Remote Patient Monitoring (RPM) solutions designed to enhance patient care and streamline healthcare delivery. By leveraging advanced technology, Mass Health offers real-time monitoring, health analytics, and expert consultation services to improve patient outcomes, particularly for chronic conditions such as hypertension, diabetes, and heart disease. The company focuses on seamless integration with existing healthcare workflows, ensuring ease of use for healthcare providers and maintaining high standards of data security and compliance. Mass Health's innovative approach empowers healthcare practices to manage patient care more efficiently and effectively from a distance, transforming the landscape of digital healthcare. Manager, Risk Adjustment Job not on LinkedIn 🔥 5 minutes ago 🍂 Massachusetts – Remote 💵 $90k / year ⏰ Full Time 🟠 Senior 🔴 Lead 🎲 Risk Apply Now Find Hiring Managers Customize resume for this job Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Oversee Mass Advantage's risk adjustment activities and strategy.
Execute Medicare risk adjustment programs to fulfill business objectives.
Manage external vendors and conduct regulatory audits and compliance.
Analyze Medicare revenue initiatives for senior products.
Coordinate risk adjustment initiatives across departments and provider partners. 🎯 Requirements
Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
Registered Nurse (RN) desired.
CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.
Strong Microsoft Office skills (Word, Outlook, Excel and PP). Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Director of Governance 🔥 1 hour ago Blue Alliance 201 - 500 💸 Finance 🏢 Enterprise ☁️ SaaS Website LinkedIn All Job Openings Director of Governance responsible for GRC services and compliance maturity at LayerCake, a trusted managed services provider for IT operations. 🇺🇸 United States – Remote ⏰ Full Time 🔴 Lead 🎲 Risk Risk Adjustment Coding Manager 🔥 4 hours ago IMH 501 - 1000 🤝 B2B 🏪 Marketplace 👥 B2C Website LinkedIn All Job Openings Manager overseeing the HCC Coding Analyst team and development of coding policies at Intermountain Health. Ensuring compliance with government regulations and optimizing coding activities. 🇺🇸 United States – Remote 💵 $38 - $59 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 🎲 Risk Senior Risk Control Analyst 🔥 7 hours ago Encova Insurance 1001 - 5000 💸 Finance 👥 B2C Website LinkedIn All Job Openings Senior Risk Control Analyst at Encova Insurance evaluating risk for new business and renewal accounts. Analyzing data and providing actionable insights to support underwriting decisions. 🇺🇸 United States – Remote 💵 $86.7k - $138.8k / year ⏰ Full Time 🟠 Senior 🎲 Risk Senior Risk Control Consultant 🔥 9 hours ago UFG Insurance 501 - 1000 💸 Finance 🤝 B2B Website LinkedIn All Job Openings Dynamic professional in Risk Control Team managing complex risk assessments. Leading initiatives across various industries with a focus on client collaboration and technical guidance. 🇺🇸 United States – Remote 💵 $112k - $143k / year ⏰ Full Time 🟠 Senior 🎲 Risk Associate Director – Governance, Data Management Operations Enablement 🔥 11 hours ago IQVIA 10,000+ employees ⚕️ Healthcare Insurance 🧬 Biotechnology 🤖 Artificial Intelligence Website LinkedIn All Job Openings Associate Director leading data governance and compliance initiatives in IQVIA Digital. Partnering with cross-functional teams to operationalize data governance and compliance requirements. 🇺🇸 United States – Remote 💵 $84.4k - $235.3k / year 💰 $1G Post-IPO Debt on 2023-05 ⏰ Full Time 🟠 Senior 🎲 Risk 🦅 H1B Visa Sponsor View More Risk Manager Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

Medicare risk adjustmentRADV experienceCMS-HCC modelSQLPower BITableaudata analysiscodingchart retrievalin-home assessment

Soft Skills

analytical skillsvendor managementcompliance managementcross-department coordinationstrategic oversight

Certifications

Registered Nurse (RN)Certified Risk Adjustment Coder (CRC)Certified Professional Coder (CPC)Certified Coding Specialist (CCS)