Risk Adjustment Director

Central California Alliance for Health

Risk Adjustment Director overseeing operations and strategy for Risk Adjustment Department at Alliance. Focusing on managed care and Medicare risk adjustments in California.

Posted 4/28/2026full-timeCalifornia • 🇺🇸 United StatesLead💰 $200,000 - $250,000 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance’s Risk Adjustment Department functions
Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations
Direct, manage, and supervise Risk Adjustment Department staff

Requirements

What you’ll need

A motivated and seasoned leader in the managed care industry, with expertise in risk adjustments
Excellent communication skills, with strength in building relationships and partnering with cross-functional teams.
Champion accountability across the organization
Experience in overseeing the Medicare Risk Adjustment life cycle
Strong data and analytical skills, including SQL, dashboarding, and reporting
Be invested in staff development and empowering teams to do their best work
Medi-Cal experience is a plus
Knowledge of the managed care industry and of Medicare health insurance payment methodologies
Knowledge of Medicare (Hierarchical Condition Categories) risk adjustment models
Knowledge of methods and techniques of developing and delivering data management strategies
Knowledge of principles and practices of provider reimbursement methodologies, pricing, and fee schedules
Ability to demonstrate strong analytical skills
Ability to perform complex analysis related to rate negotiations and health care cost reports
Ability to provide leadership and facilitate meetings
Bachelor's degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field
A minimum of ten years of experience in healthcare finance or analytics
A minimum of five years of experience with Medicare risk adjustment processes
A minimum of three years of supervisory experience.

Benefits

Comp & perks

Medical, Dental and Vision Plans
Ample Paid Time Off
12 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

SQLdashboardingreportingrisk adjustment methodologiesdata management strategiesprovider reimbursement methodologiesMedicare risk adjustment processesanalytical skillscomplex analysishealthcare finance

Soft Skills

communication skillsrelationship buildingcross-functional collaborationaccountabilitystaff developmentempowermentleadershipfacilitationstrategic managementsupervisory skills