Director, Quality & Risk Adjustment Operations

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❄️ Minnesota – Remote

❄️ Minnesota – Remote

⏰ Full Time

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Herself Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Herself Health is a primary care practice specifically designed for women aged 65 and above. The practice focuses on providing comprehensive care that incorporates both physical and emotional health, tailored to meet individual health goals. They offer solutions for health conditions commonly affecting older women, such as arthritis, weight management, heart health, bone health, and mental health. Herself Health accepts a variety of insurance plans, including Medicare Part B, Medicare Supplement, and most Medicare Advantage plans. Their facilities are located in the Minneapolis/St. Paul area, with clinic hours from Monday to Friday and additional 24/7 call support.

📋 Description

• Develop the strategy and lead execution of Herself Health’s HEDIS Quality and Burden of Illness (Risk Adjustment) programs • Drive high-quality patient outcomes, complete documentation, and contractual performance targets • Partner collaboratively with the Chief Medical Officer on risk adjustment coding accuracy and clinically effective quality-gap strategies • Partner with payer strategy and clinical operations teams on value-based care contracts • Own the strategic vision, strategic plan, and day-to-day performance of Quality and BOI programs • Provide strategic direction, coaching, and enablement for VBC leaders overseeing Care Coordinators and Provider Educators • Drive adoption of best practices among providers and clinical teams • Serve as the subject matter expert on HEDIS and risk adjustment, including CMS changes and communications • Manage strategic vendor partnerships, contractual compliance, and improvement efforts • Work with internal leadership, the board, investors, and external partners

🎯 Requirements

• Authorized to work in the United States • Bachelor’s degree required; master’s degree highly preferred • Expert knowledge of CMS’ HEDIS Quality program and measures • Expert knowledge of CMS regulatory rules and coding guidelines for Medicare Advantage risk adjustment coding • Ability to analyze data to understand performance trends and drivers • Ability to lead through influence and change • Strong communication and presentation skills • Experience working cross-functionally with providers, care teams, operations, and finance • Experience working in Electronic Medical Record (EMR) systems; Athena experience desirable • 7+ years of HEDIS Quality and Risk Adjustment experience • 5+ years of experience leading teams • Ability to travel up to 25% to MN clinics