Vice President, Retrospective Programs

Role Description

The Vice President, Retrospective Programs leads the enterprise retrospective risk adjustment operations team, with direct responsibility for functions including:

• Chart retrieval
• Coding operations
• Coding quality
• Supplemental data feeds
• Chart management
• Retrospective analytics strategy across Centene's Medicare, Marketplace, and Medicaid markets

This position will oversee an internal enterprise operations team, manage vendors, and coordinate with market teams. This leader drives operational excellence, compliance discipline, vendor accountability, and cross-functional alignment to deliver accurate, timely, and sustainable program outcomes while also providing input into overall risk adjustment strategy.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, Clinical Discipline, Health Information Management, Analytics, or related field required
• Master's degree in a related field preferred
• 10+ years of progressive healthcare leadership experience, including risk adjustment, provider engagement, clinical documentation improvement, quality, claims, vendor management, or related healthcare operations required
• Experience leading enterprise programs across multiple markets and lines of business required
• Demonstrated success leading strategic initiatives, provider-facing programs, vendor partnerships, and cross-functional teams required
• Strong knowledge of risk adjustment methodologies, healthcare operations, provider documentation, and regulatory requirements required
• Proven executive leadership, communication, and stakeholder management skills required
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position

Requirements

• 10+ years experience operations leadership experience, retrospective programs, coding, chart retrieval, quality data integrity preferred
• Experience leading Risk Adjustment functions across multiple markets and multiple lines of business (Medicare, Marketplace, Medicaid) National payer experience preferred

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Company Description

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.