Lead, Organic Risk Adjustment

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

🎲 Risk

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Build and operationalize Humana's Organic Risk Adjustment program • Design and implement workflows, playbooks, provider engagement approaches, and reporting processes from the ground up • Identify opportunities, develop action plans, and drive execution through completion • Manage multiple initiatives simultaneously and ensure measurable business outcomes • Serve as the point person for day-to-day execution of key Organic Risk Adjustment initiatives • Create structure, processes, and operating models where established solutions do not yet exist • Translate strategic priorities into executable work plans and deliverables • Lead complex, cross-functional initiatives involving clinical, operational, analytical, and business partners • Partner with senior leaders to identify opportunities, align priorities, and remove execution barriers • Challenge existing processes and traditional approaches to create effective, scalable, and sustainable solutions • Influence decisions and drive action across stakeholders without direct authority • Help shape the future direction and operating model of Organic Risk Adjustment • Foster innovation, continuous improvement, and accountability • Partner with providers, practice leaders, operations teams, and clinical stakeholders to improve performance and outcomes • Develop practical solutions that fit existing provider and operational workflows • Facilitate meetings, maintain alignment, and ensure follow-through on commitments and action plans • Build working relationships across diverse stakeholders and business partners • Analyze data to identify performance improvement opportunities and operational insights • Translate findings into actionable recommendations and implementation plans • Monitor program outcomes and adjust strategies based on results • Develop reporting approaches that support decision-making, accountability, and continuous improvement

🎯 Requirements

• Demonstrated success leading large-scale, cross-functional initiatives from concept through implementation • Experience in Medicare Advantage, value-based care, population health, healthcare operations, quality improvement, risk adjustment, or related healthcare performance programs • Experience partnering with senior leaders to drive organizational change and operational improvement • Proven ability to influence stakeholders across clinical, operational, analytical, and business teams • Strong problem-solving skills with the ability to navigate ambiguity and create structure in evolving environments • Ability to analyze data trends, identify opportunities, and translate insights into operational action plans • Strong communication, facilitation, and stakeholder management skills • This role is not eligible for work visa sponsorship • Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps • Ability to work from a dedicated space without ongoing interruptions to protect member PHI / HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness support • Smart healthcare decision support

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