Executive Director, Risk Adjustment & RAF Excellence

Optum; New York (NY); On-site; USD 135,000 - 231,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401(k) contribution

Job summary

Optum in New York, NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment strategy and operational performance across networks. This role directly influences financial performance through accurate risk capture and compliant coding in value-based arrangements.

The leader collaborates with provider organizations, clinical leadership, and compliance teams to embed risk workflows into care delivery while ensuring audit readiness and regulatory compliance.

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.

Responsibilities

• Lead enterprise risk adjustment strategy for Medicare Advantage, Medicaid, and Commercial risk contracts.
• Drive accurate and sustainable RAF performance through prospective and retrospective programs.
• Develop multi-year roadmap for risk capture, documentation improvement, and coding optimization.
• Serve as strategic advisor to provider groups on documentation and coding performance.
• Oversee coding programs including chart review, CDI, education, and audit processes.

Skills

Risk adjustment

Coding

Value-based care

CMS-HCC knowledge

ICD-10 proficiency

Job description

Optum in New York, NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment strategy and operational performance across networks. This role directly influences financial performance through accurate risk capture and compliant coding in value-based arrangements.

The leader collaborates with provider organizations, clinical leadership, and compliance teams to embed risk workflows into care delivery while ensuring audit readiness and regulatory compliance.