Director, Proactive Risk Adjustment & Care Strategy

Inland-Empire-Health-Plan-; Rancho Cucamonga (CA); Hybrid; USD 154,000 - 204,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical Insurance with Dental and Visn

Life, short-term, and long-term-disb

Career development

Wellness programs

Flexible Spending Account – HealthCare

CalPERS retirement

457(b) option with a contributionmatch

Paid life insurance for employees

Pet care insurance

Job summary

Inland Empire Health Plan (IEHP) in Rancho Cucamonga, CA, is seeking a Director of Risk Adjustment Prospective Programs to lead proactive, patient-centered initiatives across in-home, virtual, and point-of-care settings.

This role focuses on designing scalable workflows, improving documentation accuracy for CMS compliance, reducing provider burden, and delivering measurable ROI through advanced analytics and vendor management. Hybrid schedule with travel as needed.

Qualifications

• 8+ years in healthcare managed care or risk adjustment operations.
• 3+ years leading teams, projects or cross-functional initiatives.
• Experience with prospective risk adjustment, MEAT criteria, and CMS requirements.
• Bachelor’s degree in nursing, public health, healthcare administration or related field.
• CRC/CPC certification or CDI credential preferred; CA RN/NP licensure preferred.

Responsibilities

• Design, implement and scale prospective risk adjustment programs.
• Lead in-home and virtual assessment campaigns with compliant documentation.
• Reduce workflow burden by creating EHR smart phrases and macros.
• Engage providers and manage value-based incentives and quality programs.
• Oversee vendor selection, performance, budgets, and ROI for risk adjustment.
• Governance, reporting and continuous improvement of risk adjustment initiatives.
• Coordinate with IPA Medical Directors to integrate data into care gaps.

Skills

Leadership

Data analytics

Communication

Change management

Excel/BI

Education

Bachelor’s degree

Master’s degree preferred

RN/NP licensure preferred (CA)

Tools

Epic/EHR integrations

Excel/BI tools

CRM systems

Job description

Inland Empire Health Plan (IEHP) in Rancho Cucamonga, CA, is seeking a Director of Risk Adjustment Prospective Programs to lead proactive, patient-centered initiatives across in-home, virtual, and point-of-care settings.

This role focuses on designing scalable workflows, improving documentation accuracy for CMS compliance, reducing provider burden, and delivering measurable ROI through advanced analytics and vendor management. Hybrid schedule with travel as needed.