Senior Director, Risk Adjustment

🔥 0 minutes ago

🌵 Arizona, Florida, +15 more states – Remote

🌵 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

💵 $150k - $225k / year

⏰ Full Time

🟠 Senior

🎲 Risk

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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