Director, Quality & Risk Adjustment Operations

This is a fully remote position, open to applicants in Minnesota.

📋 Description

• Formulate and oversee the implementation of Herself Health’s HEDIS Quality and Burden of Illness (Risk Adjustment) initiatives.

• Facilitate superior patient outcomes, ensure comprehensive documentation, and meet contractual performance objectives.

• Collaborate closely with the Chief Medical Officer to enhance risk adjustment coding accuracy and develop clinically effective quality-gap strategies.

• Work alongside payer strategy and clinical operations teams on value-based care agreements.

• Take ownership of the strategic vision, planning, and daily operations of Quality and BOI programs.

• Provide strategic guidance, coaching, and support for value-based care leaders managing Care Coordinators and Provider Educators.

• Promote the adoption of best practices within provider and clinical teams.

• Act as the subject matter expert on HEDIS and risk adjustment, keeping abreast of CMS updates and communications.

• Oversee strategic vendor partnerships, ensure contractual compliance, and spearhead improvement initiatives.

• Collaborate with internal leadership, the board, investors, and external stakeholders.

⛳️ Requirements

• Must be authorized to work in the United States.

• A bachelor's degree is required; a master's degree is highly preferred.

• In-depth knowledge of CMS’ HEDIS Quality program and its measures.

• Extensive understanding of CMS regulatory rules and coding guidelines related to Medicare Advantage risk adjustment coding.

• Proficient in data analysis to discern performance trends and contributing factors.

• Ability to lead through influence and drive change.

• Exceptional communication and presentation abilities.

• Proven experience working collaboratively across functions with providers, care teams, operations, and finance.

• Familiarity with Electronic Medical Record (EMR) systems; experience with Athena is desirable.

• Over 7 years of experience in HEDIS Quality and Risk Adjustment.

• More than 5 years of experience in leadership roles.

• Willingness to travel up to 25% to clinics in Minnesota.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and continuing education.

• Supportive and collaborative work environment.