About this role
We’re seeking a strategic healthcare operations leader to help take our Risk Adjustment organization to the next level. This role will focus on building structure, standardizing processes, developing leaders, and driving accountability across a complex, highly regulated, multi-market organization. You’ll oversee multiple levels of leadership and partner closely with Clinical Operations, Quality, Network Management, Analytics, and executive leadership. You’ll translate organizational priorities into clear operational expectations while also identifying challenges and bringing solutions back to leadership. The ideal candidate is a strong operator and people leader who can inherit an evolving organization, identify opportunities for improvement, establish scalable processes, and lead teams through change. Deep Risk Adjustment expertise is preferred but not required. We’re equally interested in leaders with backgrounds in healthcare operations, quality, population health, managed care, or value-based care who have demonstrated success building teams and improving complex processes. The right person will be structured, collaborative, comfortable with accountability, and capable of operating independently in an environment where there is significant opportunity to build and improve. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Strategic Leadership Develop and execute enterprise-wide risk adjustment and documentation improvement strategies aligned with organizational and value-based care objectives. Establish departmental goals, key performance indicators (KPIs), and operational plans that drive measurable improvements in risk capture, coding accuracy, provider engagement, and financial performance. Identify opportunities to enhance revenue integrity, operational efficiency, and program effectiveness through innovative solutions and data-driven decision making. Provide leadership and guidance on emerging regulatory requirements, risk adjustment methodologies, and industry best practices. Program Oversight Provide oversight of risk adjustment, coding, provider education, documentation improvement, retrospective review, and prospective outreach programs. Ensure consistent implementation of operational standards, workflows, and performance expectations across all markets and business units. Lead cross-functional initiatives involving clinical services, provider operations, analytics, quality, compliance, and finance teams. Monitor program outcomes and implement strategic improvements to maximize organizational performance. Financial and Operational Management Accountable for achievement of risk adjustment, quality, productivity, compliance, and financial performance goals. Develop and manage departmental budgets, workforce planning, resource allocation, and vendor expenditures. Evaluate operational trends, performance metrics, and financial results to identify opportunities for growth and process improvement. Implement corrective action plans when performance objectives are not being achieved. Provider and Stakeholder Management Build and maintain strategic relationships with executive leadership, provider groups, health plans, vendors, and external stakeholders. Partner with providers and operational leaders to support documentation excellence, coding accuracy, and value-based care success. Present business performance, strategic recommendations, and operational results to senior leadership and executive stakeholders. Oversee vendor management activities, including performance monitoring, contract compliance, and service delivery expectations. Regulatory Compliance and Quality Ensure organizational compliance with CMS, NCQA, DMHC, HHS, and other applicable federal, state, and health plan requirements. Oversee internal monitoring, audits, and regulatory review activities related to risk adjustment and documentation practices. Collaborate with compliance and quality teams to implement corrective actions and continuous improvement initiatives. Promote a culture of ethical documentation, coding integrity, and regulatory compliance. Leadership and Talent Development Provides direct leadership and oversight to Senior Managers, Managers, and departmental leadership teams responsible for risk adjustment operations, coding, provider engagement, analytics, and program administration. Establishes strategic direction, performance expectations, and operational priorities across multiple functional areas and levels of leadership. Coaches, mentors, and develops leaders to strengthen organizational capability, succession planning, and employee engagement. Evaluates organizational structure and staffing needs to ensure resources are appropriately aligned with business objectives and growth strategies. Drives a culture of accountability, collaboration, innovation, and continuous improvement throughout the department. Oversees talent management activities including recruitment, performance management, employee development, succession planning, and leadership development. Ensures consistency in management practices, employee engagement, and performance standards across all teams and markets. Partners with executive leadership to anticipate future workforce needs and develop organizational capabilities that support long-term strategic objectives. Other duties as assigned.