Senior Director, Risk Adjustment Market Performance

This is a fully remote position, open to applicants in New York, +1 more state.

📋 Description

• Provide executive leadership for risk adjustment performance across various markets and lines of business.

• Act as the primary liaison between Enterprise Risk Adjustment and market leadership.

• Lead market risk adjustment strategies and initiatives to meet enterprise performance objectives.

• Set and monitor targets for risk score capture, coding accuracy, documentation quality, chart retrieval, and provider performance.

• Identify and prioritize high-impact provider organizations and strategic partnerships.

• Cultivate executive-level relationships with provider organizations, integrating risk adjustment priorities into value-based care and population health strategies.

• Facilitate direct collaboration among risk adjustment, provider engagement, quality, network management, actuarial, clinical operations, analytics, and external partners.

• Establish governance structures, accountability frameworks, and performance review processes.

• Create executive reports, dashboards, and action plans to evaluate results and address performance gaps.

• Perform risk assessments, root-cause analyses, and targeted interventions.

• Advise enterprise and market leadership on provider investments, resource allocation, operational model enhancements, and best practices.

• Execute other duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship, both now and in the future.

• A Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Analytics, Public Health, or a related field, or equivalent experience is required.

• A minimum of 8 years of experience in healthcare operations, risk adjustment, managed care, provider performance, value-based care, analytics, clinical operations, or a related healthcare field is required.

• At least 3 years of management experience overseeing complex cross-functional initiatives and enhancing organizational performance is required.

• Over 5 years of experience presenting operational performance, business outcomes, and strategic recommendations to executive leadership is required.

• Proven expertise in risk adjustment operations, provider performance enhancement, coding and documentation programs, healthcare analytics, and managed care is required.

• Experience supporting multiple lines of business, including Medicaid, Medicare, Marketplace, and Commercial, is preferred.

• Experience in developing governance frameworks, executive reporting, accountability models, and strategies for performance improvement is preferred.

• Knowledge of provider engagement, value-based care, population health, and healthcare reimbursement methodologies is preferred.

• A demonstrated ability to influence across matrixed organizations and lead enterprise-to-market performance initiatives that yield measurable results is preferred.

• A Master's Degree in Business Administration, Healthcare Administration, Public Health, Finance, or a related field is preferred.

• PMP, Lean Six Sigma, CPHQ, or similar certifications in healthcare operations, performance improvement, or project management are preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements with remote, hybrid, field, or office schedules.

• Additional incentive forms may be included in total compensation.

• We are a diversity-focused equal opportunity employer.