Sr Mgr, Quality Risk Adjustment (Health plan/MCO experienced)

📋 Description

• • The Senior Manager, Quality Risk Adjustment oversees the Quality Risk Adjustment (QRA) Medical Record Review (MRR) program, ensuring compliance with regulatory standards while optimizing quality outcomes through strategic leadership and AI-driven innovation.
• • Day-to-day responsibilities include leading and managing the MRR team, developing strategic plans for risk adjustment processes, managing outsourced vendors, conducting audits for accuracy and efficiency, researching and deploying AI/NLP solutions, collaborating with cross-functional teams (Data Science, IT, Sourcing), improving workflows, developing training programs, monitoring KPIs, and translating business needs into technical specifications for AI initiatives.
• • CareSource Management Group Company is a mission-driven healthcare organization dedicated to improving health outcomes and fostering belonging, with a commitment to equal opportunity employment and comprehensive employee well-being.
• • In this role, the individual will develop expertise in AI applications for healthcare data, strengthen leadership in vendor and team management, deepen knowledge of CMS risk adjustment models and regulatory compliance, and drive measurable improvements in operational efficiency and quality metrics through innovation and process optimization.