Risk Adjustment Specialist (Clinical)

Location: Remote within the United States; Pennsylvania residence is not required, but EST working hours are required. Some travel may be required.

Salary: $56,200–$101,000 per year

Company

hirify.global provides healthcare services focused on improving access to care and health outcomes for individuals, families, and communities.

What you will do

• Support the development and maintenance of risk adjustment programs and reporting across all lines of business.
• Assist with company-wide risk adjustment initiatives and vendor management.
• Train providers and health plan staff on risk adjustment methodologies and activities.
• Research best practices and help integrate them into operational processes.
• Develop workflows aligned with product requirements and local market dynamics.
• Prepare for and participate in committee and provider meetings.

Requirements

• Active RN license required.
• Clinical or quality improvement experience and HEDIS experience required.
• Bachelor’s degree or equivalent experience.
• At least two years of quality improvement or clinical experience.
• Availability to work EST hours.
• Experience in managed care and a bachelor’s degree in nursing are preferred.

Culture & Benefits

• Remote, hybrid, field, and office work schedules are supported.
• Health insurance and paid time off, including holidays.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Additional compensation may include incentives, subject to eligibility.