Lead, Organic Risk Adjustment

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

📋 Description

• Develop and implement Humana's Organic Risk Adjustment program.

• Create and execute workflows, playbooks, provider engagement strategies, and reporting procedures from inception.

• Recognize opportunities, formulate action plans, and ensure execution until completion.

• Oversee multiple projects concurrently and guarantee measurable business results.

• Act as the main contact for the daily execution of key Organic Risk Adjustment programs.

• Establish structures, processes, and operational models where existing solutions are lacking.

• Convert strategic objectives into actionable work plans and deliverables.

• Lead intricate, cross-functional projects involving clinical, operational, analytical, and business collaborators.

• Collaborate with senior leadership to uncover opportunities, align priorities, and eliminate execution challenges.

• Question existing processes and conventional methods to devise effective, scalable, and sustainable solutions.

• Influence decisions and motivate action among stakeholders without direct authority.

• Contribute to shaping the future direction and operational model of Organic Risk Adjustment.

• Encourage innovation, continuous improvement, and accountability.

• Collaborate with providers, practice leaders, operations teams, and clinical stakeholders to enhance performance and outcomes.

• Create practical solutions that integrate seamlessly into existing provider and operational workflows.

• Organize meetings, ensure alignment, and follow through on commitments and action plans.

• Build strong working relationships with a diverse range of stakeholders and business partners.

• Analyze data to uncover performance enhancement opportunities and operational insights.

• Convert findings into actionable recommendations and implementation strategies.

• Track program outcomes and refine strategies based on results.

• Develop reporting methods that facilitate decision-making, accountability, and ongoing improvement.

⛳️ Requirements

• Proven experience in leading large-scale, cross-functional projects from conception to execution.

• Background in Medicare Advantage, value-based care, population health, healthcare operations, quality improvement, risk adjustment, or similar healthcare performance programs.

• Experience collaborating with senior leaders to promote organizational change and operational enhancements.

• Established ability to influence stakeholders across clinical, operational, analytical, and business disciplines.

• Strong problem-solving capabilities with the capacity to navigate uncertainty and build structure in dynamic environments.

• Proficient in analyzing data trends, recognizing opportunities, and translating insights into operational action plans.

• Excellent communication, facilitation, and stakeholder management abilities.

• This position does not qualify for work visa sponsorship.

• Home internet must have a minimum download speed of 25 Mbps and upload speed of 10 Mbps.

• Capability to work from a dedicated area without continuous interruptions to safeguard member PHI / HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on both company and individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Personal wellness support.

• Smart healthcare decision support.