Director, Risk Adjustment Strategy

ISHE; New York (NY); Hybride; USD 135 000 - 231 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Equity stock purchase plan

401k contribution

Résumé du poste

Optum NY in New York, NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment programs across Optum East. You will drive strategic execution, documentation, and coding practices to ensure accurate RAF performance in Medicare Advantage, Medicaid, and Commercial contracts.

The role requires 10+ years in risk adjustment or value-based care, deep CMS-HCC and ICD-10 expertise, and proven ability to partner with provider groups, clinical leadership, and audit teams.

Qualifications

• 10+ years of experience in risk adjustment, coding, or value-based care.
• Experience working with provider organizations in risk-bearing models.
• Deep expertise in CMS-HCC, ICD-10, and documentation standards.
• Solid understanding of regulatory audits and compliance frameworks.

Responsabilités

• Lead enterprise risk adjustment strategy for Medicare Advantage, Medicaid, and Commercial risk contracts
• Drive RAF performance through prospective and retrospective programs
• Develop multi-year roadmap for risk capture, documentation improvement, and coding optimization
• Oversee coding programs including chart review, CDI, education, and audit processes
• Ensure adherence to ICD-10, CMS-HCC, and state-specific risk methodologies
• Standardize best practices across employed and independent networks
• Ensure compliance with CMS, HHS, and state regulatory requirements
• Partner with compliance and legal on audits, RADV readiness, and corrective actions
• Drive actionable reporting on RAF performance, coding accuracy, and documentation trends
• Partner with analytics teams to identify risk opportunities and provider-level insights

Connaissances

Risk adjustment

CMS-HCC

Regulatory audits

Provider partnerships

Description du poste

Optum NY in New York, NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment programs across Optum East. You will drive strategic execution, documentation, and coding practices to ensure accurate RAF performance in Medicare Advantage, Medicaid, and Commercial contracts.

The role requires 10+ years in risk adjustment or value-based care, deep CMS-HCC and ICD-10 expertise, and proven ability to partner with provider groups, clinical leadership, and audit teams.