Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
April 30, 2026
Full Job Description
đź“‹ Description
- • The Sr. Manager, Medical Risk Adjustment Analytics leads the day-to-day operations of the risk adjustment function across all lines of business, ensuring accurate identification of member-level risk opportunities and effective intervention strategies.
- • Oversees data accuracy, compliance with CMS and state regulations, and tracks ROI performance at the intervention level for Medicare, Medicaid, and ACA/Marketplace programs.
- • Manages and develops a team of analysts, responsible for recruiting, performance reviews, coaching, and fostering a high-performing culture aligned with organizational goals.
- • Partners with internal and external stakeholders to ensure timely and accurate data submission for CMS attestation and supports financial forecasting related to risk adjustment revenue.
- • Drives process improvement by maintaining documentation, analyzing clinical reports, and ensuring adherence to evolving healthcare reporting standards.
🎯 Requirements
- • Bachelor’s degree in Finance, Business Administration, or a clinical-related field or equivalent work experience
- • Seven (7) years of experience analyzing healthcare claims data and/or risk scores, including database experience with SAS, SQL, or Access
- • Three (3) years of management or supervisory experience
- • Expert proficiency in Microsoft Excel and advanced skills in Word, PowerPoint, and Outlook
- • In-depth knowledge of Medicare/CMS Risk Adjustment regulations, ICD-10, and CPT coding systems
🏖️ Benefits
- • Competitive salary range of $113,000 to $197,700 annually, with potential for performance-based bonuses
- • Comprehensive total rewards package focused on employee well-being
- • Opportunity to lead and develop a team while influencing executive-level stakeholders
- • Remote work flexibility with a general office environment option
- • Exposure to strategic healthcare initiatives involving Medicare, Medicaid, and ACA/Marketplace risk adjustment programs
Skills & Technologies
About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
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