Senior Director, Risk Adjustment

Medica

Senior Director leading Risk Adjustment operations for nonprofit health plan. Driving improvements in data management and compliance across healthcare service lines.

Posted 6/4/2026full-timeRemote • Arizona, Florida, Illinois, Iowa, Kansas, Kentucky, Minnesota, Missouri, Montana, New York, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Virginia, Wisconsin • 🇺🇸 United StatesSenior💰 $150,000 - $225,015 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data collectiondata processingencounter creationsubmission controlsreconciliationaudit readinessclaims-based dataperformance measurementRisk Adjustmentvendor management

Soft Skills

leadershipcommunicationorganizational skillscollaborationexecutive-level communicationcomfort operating in ambiguity

Certifications

Bachelor's degreeAdvanced degree