Manager, Risk Adjustment Vendor & Performance Management
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Risk adjustment vendor manager optimizing analytics, KPIs, contracts, and performance for Horizon Blue Cross Blue Shield of New Jersey. Leading enterprise vendor strategy across Commercial, Medicare, and Medicaid programs.
Responsibilities:
- Develop and lead risk adjustment vendor strategy aligned to enterprise goals
- Identify vendor needs, source and evaluate partners, and define success measures
- Negotiate contracts and own day-to-day vendor relationships
- Lead RFPs, vendor selection, implementation, and offboarding
- Manage onboarding and wind-down activities including data retention and destruction
- Ensure effective transition and integration of vendor services
- Design and maintain KPI frameworks for vendors and internal operations
- Develop models and reporting to measure financial impact and operational outcomes
- Analyze performance trends and identify improvement opportunities
- Audit internal and vendor reporting for accuracy and completeness
- Ensure data integrity and adherence to measurement standards
- Support compliance and internal control requirements
- Monitor vendor spend, billing, and budget performance
- Develop forecasts and provide financial insights to leadership
- Advise on budget risks and mitigation strategies
- Review and reconcile vendor invoices to ensure accurate and timely payment
- Partner with enterprise leaders to define targets and corrective actions
- Present insights and recommendations to executive stakeholders
- Mentor and guide analytics and reporting teams
Requirements:
- Bachelor’s degree preferred in business, finance, statistics, healthcare, or related field
- 6+ years healthcare or insurance experience with analytics/reporting
- 3+ years supervisory experience
- Extensive knowledge of risk adjustment and vendor performance management
- Strong analytical and statistical modeling skills
- Experience developing KPIs and performance frameworks
- Advanced Excel proficiency
- Experience with SAS, R, or SQL preferred
- Experience in ACA, Medicare, or Medicaid risk adjustment programs preferred
- CPA or CMA certification preferred
Benefits:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Similar Jobs
Director, Client Operations – Risk & Complexity Enablement
BMO Director leading remote InvestorLine operations, risk, resilience and complex client resolution. Driving service performance, modernization adoption, controls and workforce readiness across Canadian provinces.
RN II, Commercial Risk Adjustment
RN managing high-risk members and commercial risk adjustment care for Horizon Blue Cross Blue Shield of New Jersey. Coordinating outreach, wellness visits, utilization management, and individualized care plans.
VP, Sales – Risk & Quality
VP Sales growing HealthEdge’s risk adjustment and quality healthcare SaaS revenue. Expanding payer accounts through complex enterprise sales, CMS-aligned solutions, and market strategy.
Senior Benefit/Risk Associate
Senior Benefit/Risk Associate conducting pharmacovigilance signal detection and risk evaluation for PrimeVigilance. Supporting regulatory communications and patient-safety activities within global project teams.
Risk Analyst
Risk Analyst analyzing credit, underwriting, portfolio behavior, and profitability for Flex’s AI-native private bank serving business owners. Building risk models and dashboards to improve lending decisions.
Large Loss Risk Adjuster
Large Loss Risk Adjuster evaluating severe, complex claims for National General, a specialty personal and commercial insurer. Granting settlement authority and guiding litigation and coverage decisions.
Head of Risk
Head of Risk building firm-wide quantitative risk systems for Keyrock’s digital-asset trading and capital-markets businesses. Overseeing market, credit, liquidity and crypto-native risks.
Product Coordinator – MarTech Platform, Governance
Product Coordinator managing intake, access governance, and operations across enterprise MarTech platforms. Coordinating Adobe Experience Cloud and Experience Platform stakeholders for scalable governance.
Student, Data Governance Analyst
Student Data Governance Analyst applying machine learning and Python automation to protect PII and manage metadata. Supporting Sun Life's financial-services data governance and reporting initiatives.
Senior Risk Associate
Senior Risk Associate owning client, vendor, and enterprise risk assessments for Lithic's fintech card issuing platform. Driving underwriting, AI-assisted workflows, and regulatory-ready risk programs.
Data Governance Analyst
Analista de Governança de Dados & IA na Stone, empresa brasileira de tecnologia e serviços financeiros. Garantindo dados confiáveis, governança e soluções de IA para Planejamento e Controle.
Manager, Vendor Performance – Governance
Managing vendor performance, governance, compliance, and risk for Alignment Health’s Medicare Advantage health plan. Driving accountability, cost efficiency, and improved member and provider experiences.
Certified Risk Coder
Certified Risk Coder reviewing medical records and validating HCC diagnoses for Astrana Health’s value-based care programs. Educating providers and improving coding compliance remotely.
Senior Associate L3 – Cyber Data & Tech Risk Managed Services, Saviynt IAM Operations
Saviynt IAM Operations Senior Associate delivering L3 identity governance support for PwC Cyber Managed Services. Troubleshooting incidents, engineering integrations, and improving enterprise IGA stability.
Senior IAM Governance Analyst
Analista sênior de IAM governando identidades e acessos corporativos. Administrando SailPoint Identity Security Cloud e Microsoft Entra ID para proteger ativos digitais.
AVP, Medicare Risk Adjustment Performance
Executive leading enterprise Medicare risk adjustment strategy and RAF performance for Alignment Health, a senior-focused healthcare company. Overseeing providers, coding, analytics, vendors, finance, and RADV readiness.
GRC Analyst
GRC Analyst testing controls, managing audits, and assessing risk for YipitData’s alternative-data analytics business. Supporting SOC 2, vendor reviews, customer questionnaires, and AI governance.
Project Scientist – Human Health Risk Assessor
Project Scientist leading human health risk assessments for EHS Support’s environmental consulting clients. Managing projects, regulators, staff mentorship, and remedial strategy development.
Principal Identity Governance Lead
Principal Identity Governance Lead redesigning human and non-human identity governance for Hyland’s AI-powered content platform. Building secure, compliant IAM frameworks across cloud and on-premises environments.
Senior Manager, Risk & Trading
Senior risk and trading manager optimizing sportsbook operations, pricing, and risk for Fliff’s rewards-driven social sports gaming platform. Leading analysts and traders while shaping market strategies.