AVP, Medicare Risk Adjustment Performance

Alignment Health

Executive leading enterprise Medicare risk adjustment strategy and RAF performance for Alignment Health, a senior-focused healthcare company. Overseeing providers, coding, analytics, vendors, finance, and RADV readiness.

Posted 9/4/2026full-timeRemote • 🇺🇸 United StatesLead💰 $198,219 - $297,329 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Risk Adjustment strategy and operations, with a strong focus on financial performance, analytics, and compliance within the healthcare sector. Proven ability to lead cross-functional teams and drive operational excellence through data-driven decision-making and stakeholder engagement.

Highest-signal resume keywords

Risk Adjustment Strategy DevelopmentHealthcare Analytics LeadershipFinancial Performance ManagementCMS-HCC Methodology KnowledgeCross-Functional Initiative Leadership

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Risk AdjustmentHealthcare AnalyticsFinancial ForecastingData GovernanceSQL-Based AnalyticsBusiness IntelligencePerformance MeasurementOperational PlanningRegulatory ComplianceData Infrastructure Design

Soft Skills

LeadershipCommunicationOrganizationInterpersonal SkillsPresentation Skills

Tools & Technologies

ExcelData WarehousingAnalytics PlatformsReporting ToolsVendor Management Systems

Industry Keywords

Medicare AdvantageManaged CarePopulation HealthEncounter DataAudit Readiness

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Provide executive leadership for Alignment's enterprise Risk Adjustment performance strategy and operations
Lead development and execution of prospective, concurrent, and retrospective Risk Adjustment strategies
Drive provider and market execution and achieve annual RAF performance objectives
Oversee provider engagement, coding operations, chart retrieval, submission, analytics, vendor management, and revenue realization
Partner with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams
Lead the annual operating plan, including goals, measures, milestones, resources and market-level execution plans
Establish and monitor performance guidelines for quality, productivity, service levels and financial outcomes
Use analytics, reporting and strategic business analysis to identify opportunities, risks, root causes and interventions
Partner with Finance and Actuarial teams on forecasting, revenue implications, bid development and long-range planning
Establish strategic direction and performance expectations for Risk Adjustment vendors and external partners
Serve as executive sponsor for provider coding performance and documentation improvement initiatives
Develop scalable reporting, analytical and operational capabilities supporting visibility, audit readiness and reduced manual controls
Partner with DTS and enterprise analytics teams on data strategy and reporting capabilities
Define requirements for workflow modernization, automation, provider enablement and enterprise reporting
Sponsor technology initiatives improving scalability, productivity, transparency and audit readiness
Support RADV readiness, validation findings, reconciliation, diagnosis corrections and audit remediation
Establish policies, procedures, standard work and governance routines for accurate and compliant execution
Maintain knowledge of CMS requirements, model changes and regulatory guidance and translate changes into operational plans
Communicate complex operational, technical and financial information as executive insights and business narratives
Build, mentor and retain a high-performing multidisciplinary team
Develop multi-year strategies, annual goals, KPIs and resource requirements
Lead business cases for investments, operational initiatives and technology capabilities
Oversee assigned leaders and staff, including workforce planning, recruiting, training, goal-setting, performance management and coaching
Perform other duties as assigned

Requirements

What you’ll need

Ten or more years of progressive experience in managed care, Medicare Advantage, healthcare analytics, healthcare finance, risk adjustment, population health or related operations
Experience leading enterprise Risk Adjustment programs across multiple markets and provider arrangements
Demonstrated responsibility for financial performance, forecasting, strategic planning, or major business initiatives
Proven track record managing executive stakeholders and enterprise-wide programs
Seven or more years of people leadership, including development of high-performing analytical or operational teams
Bachelor’s degree in healthcare, business, finance, analytics, information systems or a related field, or equivalent relevant experience
Demonstrated knowledge of CMS-HCC risk adjustment methodology, Medicare Advantage reimbursement, coding and documentation programs, encounter data, and performance measurement
Demonstrated experience designing or leading analytics, reporting, data governance or scalable data infrastructure that supports reporting accuracy, regulatory compliance and audit readiness
Experience leading complex cross-functional initiatives and working with executives, providers, vendors, compliance partners and technical teams
Experience with risk adjustment forecasting, provider performance analytics, data warehousing, SQL-based analytics or business intelligence platforms
Experience supporting multiple government-program lines of business or large, multi-market Medicare Advantage operations
Advanced ability to translate complex data into executive-level insights, recommendations and action plans
Strong verbal, written, presentation, organization and relationship-management skills
Must be efficient in Excel; SQL knowledge preferred
Good organization skills
Good analytical skills
Good interpersonal skills
Strong communication skills

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Alignment Health Website LinkedIn All Job Openings 501 - 1000 employees Founded 2013 ⚕️ Healthcare Insurance 🛡️ Insurance 🏥 Healthcare 💰 $135M Series C on 2020-03 Healthcare Insurance
Insurance
Healthcare Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members. AVP, Medicare Risk Adjustment Performance 🔥 43 minutes ago 🇺🇸 United States – Remote 💵 $198.2k - $297.3k / year ⏰ Full Time 🔴 Lead 🎲 Risk 👻 Ghost score 0% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Provide executive leadership for Alignment's enterprise Risk Adjustment performance strategy and operations
Lead development and execution of prospective, concurrent, and retrospective Risk Adjustment strategies
Drive provider and market execution and achieve annual RAF performance objectives
Oversee provider engagement, coding operations, chart retrieval, submission, analytics, vendor management, and revenue realization
Partner with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams
Lead the annual operating plan, including goals, measures, milestones, resources and market-level execution plans
Establish and monitor performance guidelines for quality, productivity, service levels and financial outcomes
Use analytics, reporting and strategic business analysis to identify opportunities, risks, root causes and interventions
Partner with Finance and Actuarial teams on forecasting, revenue implications, bid development and long-range planning
Establish strategic direction and performance expectations for Risk Adjustment vendors and external partners
Serve as executive sponsor for provider coding performance and documentation improvement initiatives
Develop scalable reporting, analytical and operational capabilities supporting visibility, audit readiness and reduced manual controls
Partner with DTS and enterprise analytics teams on data strategy and reporting capabilities
Define requirements for workflow modernization, automation, provider enablement and enterprise reporting
Sponsor technology initiatives improving scalability, productivity, transparency and audit readiness
Support RADV readiness, validation findings, reconciliation, diagnosis corrections and audit remediation
Establish policies, procedures, standard work and governance routines for accurate and compliant execution
Maintain knowledge of CMS requirements, model changes and regulatory guidance and translate changes into operational plans
Communicate complex operational, technical and financial information as executive insights and business narratives
Build, mentor and retain a high-performing multidisciplinary team
Develop multi-year strategies, annual goals, KPIs and resource requirements
Lead business cases for investments, operational initiatives and technology capabilities
Oversee assigned leaders and staff, including workforce planning, recruiting, training, goal-setting, performance management and coaching
Perform other duties as assigned 🎯 Requirements
Ten or more years of progressive experience in managed care, Medicare Advantage, healthcare analytics, healthcare finance, risk adjustment, population health or related operations
Experience leading enterprise Risk Adjustment programs across multiple markets and provider arrangements
Demonstrated responsibility for financial performance, forecasting, strategic planning, or major business initiatives
Proven track record managing executive stakeholders and enterprise-wide programs
Seven or more years of people leadership, including development of high-performing analytical or operational teams
Bachelor’s degree in healthcare, business, finance, analytics, information systems or a related field, or equivalent relevant experience
Demonstrated knowledge of CMS-HCC risk adjustment methodology, Medicare Advantage reimbursement, coding and documentation programs, encounter data, and performance measurement
Demonstrated experience designing or leading analytics, reporting, data governance or scalable data infrastructure that supports reporting accuracy, regulatory compliance and audit readiness
Experience leading complex cross-functional initiatives and working with executives, providers, vendors, compliance partners and technical teams
Experience with risk adjustment forecasting, provider performance analytics, data warehousing, SQL-based analytics or business intelligence platforms
Experience supporting multiple government-program lines of business or large, multi-market Medicare Advantage operations
Advanced ability to translate complex data into executive-level insights, recommendations and action plans
Strong verbal, written, presentation, organization and relationship-management skills
Must be efficient in Excel; SQL knowledge preferred
Good organization skills
Good analytical skills
Good interpersonal skills
Strong communication skills Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Director, Data Governance 🔥 10 hours ago Veeam Software 1001 - 5000 💼 Consulting 📦 Logistics ☁️ SaaS Website LinkedIn All Job Openings Director governing certified, AI-ready data across Veeam’s Databricks and Atlan ecosystem. Building trust scoring, lineage, and governance standards for enterprise data. 🇺🇸 United States – Remote 💵 $249.9k - $464.1k / year 💰 $500M Private Equity Round on 2019-01 ⏰ Full Time 🔴 Lead 🎲 Risk 🦅 H1B Visa Sponsor Risk Engineer 🔥 12 hours ago OdysseyRe 501 - 1000 🛡️ Insurance 💸 Finance Website LinkedIn All Job Openings Risk Engineer supporting Hudson’s subcontractor default insurance product for contractor customers. Applying construction expertise to reduce subcontractor default risk through consultation, training, and risk controls. 🇺🇸 United States – Remote 💰 Post-IPO Equity on 2009-09 ⏰ Full Time 🟠 Senior 🔴 Lead 🎲 Risk Project Scientist – Human Health Risk Assessor 🕒 2 days ago EHS Support 201 - 500 💼 Consulting 🏥 Healthcare 🍽️ Food & Beverage Website LinkedIn All Job Openings Project Scientist leading human health risk assessments for EHS Support’s environmental consulting clients. Managing projects, regulators, staff mentorship, and remedial strategy development. 🇺🇸 United States – Remote ⏰ Full Time 🟠 Senior 🔴 Lead 🎲 Risk Director, VBR & Risk Adjustment 🕒 3 days ago CareSource 1001 - 5000 🏥 Healthcare 🛡️ Insurance ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Healthcare network director driving value-based contracting, risk adjustment, and provider performance at CareSource. Overseeing provider relationships, quality initiatives, financial planning, and operational improvement. 🇺🇸 United States – Remote 💵 $113k - $197.7k / year ⏰ Full Time 🔴 Lead 🎲 Risk 🦅 H1B Visa Sponsor Advisory Manager – Healthcare Risk Consulting 🕒 3 days ago RSM US LLP 10,000+ employees 💼 Consulting Website LinkedIn All Job Openings Healthcare risk consulting manager leading audits, risk assessments, and compliance programs for RSM clients. Managing teams, client relationships, engagement economics, and business development. 🇺🇸 United States – Remote 💵 $101k - $203k / year ⏰ Full Time 🟠 Senior 🔴 Lead 🎲 Risk 🦅 H1B Visa Sponsor View More Risk Manager Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Remote jobs Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources About us Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs