Director,Regional Risk Adjustment

Healthcare Partners Arcadia , CA 91066

Posted 2 weeks ago

Job Summary

You will create plans and outcomes related to Risk Adjustment. Priorities include being the accountable leader for the region, as well as providing high-level operational direction. In collaboration with the El Segundo central Risk Adjustment Department, multiple partners, the Regional Director will play an essential role in performance improvement, conceiving the approach for implementation, and managing deployment of risk adjustment activities and programs.


You will direct the operations for multi-year, large-scale RAF Projects. Programs may be related to business process/technology migrations, process-design, program deployment and new plans related to RAF projects. Oversee the development of the RA program across all important areas while specifically ensuring essential metrics and timelines are met within your region.

  • Be an expert on Risk Adjustment, understanding the intricacies of the CMS Medicare model to guide compelling strategies.

  • Collaborate with the VP of Risk Adjustment to help develop a clear strategy with important performance indicators. Has knowledge in risk adjustment to participate in Joint Operations Committees and in discussions with senior leadership teams.

  • Help with the analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects.

  • Help with the development of ad hoc reports and presentations for risk adjustment projects.

  • Assist end-users to gather reporting requirements and analyze internal reporting tools.

  • Support and oversee outreach efforts on Risk Adjustment Education based on review of pre-selected charts coupled with data management, data reporting and provider scorecards.

  • Propose opportunities on strategies to ensure company goals are met. Ensures early detection of major risks and interdependencies.

  • Present HCC/RAF performance results and findings to important internal leadership.

  • Participate in supporting the Risk Adjustment Data Validation Audits.

  • Collaborate on vendor performance in the region, providing feedback, analysis and outcomes supporting goals.

  • Communicate with regional Senior Leadership Teams, including Regional Vice Presidents, CHAPs, and other team members about important deliverables, barriers and escalation that need immediate attention.

  • Demonstrate leadership and diverse teams that oversee implementation of risk adjustment interventions.

  • Interpret data and financial metrics.

  • Direct responsibility for the oversight, hands-on participation and delivery of large-scale projects/programs.

  • Organize development of enterprise level planning and program objective setting.

  • Provide strategic input on the development of program roadmaps, action plans, work plans and timelines.

  • Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies.

  • Ensure communication between the team members, business leaders and diverse teams.

  • Maintain collaborative working relationships with Claims, Enrollment, IT, our essential collaborators and contracted vendors.

  • Departments to ensure deliverables are accomplished as promised.

Job Qualifications

Required Education

Bachelor's Degree

Required Experience

  • 8-10 years of experience in Managed Care, Payer/Provider/Health Plan or Health system management.

  • 7 years of experience in Medicare Advantage.

  • 5-7 years risk adjustment experience with expertise in one or more risk adjustment markets; Chart Review or In-Home assessment or Provider education or Prospective programs or member engagement or submissions.

  • 3-5 years of experience with a large medical group or IPA

  • Leadership experience fostering a high performing team, building relations with physicians and staff at all levels.

  • Track record for achieving performance results.

  • Excellent interpersonal, with the ability to inspire and engender trust across all levels of an organization.

  • Are with bias for and problem resolution ability to be a team player.

Preferred Education

Master's Degree

Preferred Experience

  • Understand Risk Adjustment Factor methodology and approaches to support accurate coding.

  • Experience and fluent in revenue cycle management systems and other healthcare financial performance.

  • Experience with payers and billing including knowledge of ICD-10 coding guidelines.

  • Medical group/IPA experience, having and partner with multiple team members and executives.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Director,Regional Risk Adjustment

Healthcare Partners