Senior Director, Risk Adjustment

🕒 Junho 4

🌵 Arizona, Florida, +15 estados a mais – Remoto

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $150.000 - $225.015 / ano

⏰ Tempo Integral

🟠 Sênior

🎲 Riscos

🦅 Patrocina Visto H1B

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Medica

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1975

⚕️ Seguro de Saúde

🤝 Sem Fins Lucrativos

Healthcare Insurance • Non-profit

A Medica é uma organização sem fins lucrativos de planos de saúde e seguradora com mais de 50 anos de experiência, que oferece planos individuais e familiares, Medicare, Medicaid e planos de saúde fornecidos por empregadores. Ela oferece serviços aos membros e ferramentas para encontrar prestadores de serviços, gerenciar benefícios e reivindicações, programas de bem-estar e iniciativas focadas na comunidade através da Medica Foundation para promover a equidade em saúde.

Descrição

• Provide enterprise leadership to design, standardize, and improve the end to end operating model across HEDIS and Risk Adjustment • Drive improvements in data collection, processing, encounter creation and management, submission controls, reconciliation, and audit readiness • Ensure execution across internal teams, technology partners, analytics, finance, and external vendors is aligned and coordinated • Establish and maintain governance structures for regulatory compliance, audit readiness, and defensible outcomes • Own the end to end vendor operating model for Risk Adjustment • Serve as the primary integrator across Quality, Performance Outcomes, Technology, Data, Analytics, Finance, Actuarial, Provider Quality, and external partners

🎯 Requisitos

• Bachelor's degree or equivalent experience in related field; Advanced degree preferred • 12+ years of experience in healthcare performance, quality, or regulatory programs • At least 8–10 years of direct experience in Risk Adjustment across Medicare Advantage, Medicaid, and/or ACA/IFB • Experience working with CMS, NCQA, and state regulatory frameworks • Strong understanding of claims‑based data, encounter processing, and performance measurement • Experience managing and integrating vended services within an enterprise operating model • Executive‑level communication skills and comfort operating in ambiguity

🏖️ Benefícios

• competitive medical, dental, vision • PTO • Holidays • paid volunteer time off • 401K contributions • caregiver services • many other benefits to support our employees