106 Best united Jobs in Salinas, California (May 2026)

Risk Adjustment Director

6 days ago

Salinas

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission ofaccessible, quality health care guided by local innovationleadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. We have an opportunity to join the Alliance as the Risk Adjustment Director leading the Risk Adjustment Department. This position can be located in one of our service counties (Mariposa, Merced, Monterey, Santa Cruz, or San Benito) or remotely in California with expected travel to Alliance service area(s) once a quarter. Must reside in California upon hire. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Chief Financial Officer, you will: • Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance's Risk Adjustment Department functions, • Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations The Finance Division acts as the guardian of the Alliance's financial health. We track the pulse of the organization by analyzing budgets, forecasting future performance, and navigating the ever-changing economic and political landscape. To keep the Alliance financially strong and secure, we wear several hats and partner with every department in the organization to translate fiscal data into insights and action. From managing funds, to risk management, and compliance, we ensure the Alliance's responsible use of public funds. THE IDEAL CANDIDATE • A motivated and seasoned leader in the managed care industry, with expertise in risk adjustments, • Excellent communication skills, with strength in building relationships and partnering with cross-functional teams., • Champion accountability across the organization, • Experience in overseeing the Medicare Risk Adjustment life cycle, • Strong data and analytical skills, including SQL, dashboarding, and reporting, • Be invested in staff development and empowering teams to do their best work, • Medi-Cal experience is a plus To read the full position description and list of requirements, ___. • Knowledge of:, • The managed care industry and of Medicare health insurance payment methodologies, • Medicare (Hierarchical Condition Categories) risk adjustment models, • Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations, • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers, • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types, • Methods and techniques of valuating for physician and inpatient and outpatient hospital costs, • Ability to:, • Demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk, • Perform complex analysis related to rate negotiations, health care cost reports, and determination of rates for hospitals, clinics, long-term care facilities, allied health services, professional services, and specialist services, • Develop, plan, organize, and direct finance programs and activities that are complex in nature and regional in scope, • Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues, • Demonstrate a collaborative management style, build rapport, demonstrate excellent public relations skills, and effectively manage internal and external business relationships, • Education and Experience:, • Bachelor's degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field, • We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams., • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. The hiring ranges represent a goodfaith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location). OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. • Medical, Dental and Vision Plans, • Ample Paid Time Off, • 12 Paid Holidays per year, • 401(a) Retirement Plan, • 457 Deferred Compensation Plan, • Robust Health and Wellness Program We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our___. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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