Executive Director, Risk Adjustment Strategy & RAF Excellence

UnitedHealth Group; New York (NY); Hybrid; USD 135,000 - 231,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401(k) contribution match

Job summary

UnitedHealth Group's Optum NY in New York, NY seeks an Executive Director of Risk Adjustment to lead enterprise-wide risk adjustment programs across provider networks, ensuring accurate, compliant and sustainable RAF performance.

This leader partners with provider organizations, clinical leadership, coding teams, and analytics to embed risk capture into workflows while maintaining 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 contracts.
• Drive accurate RAF performance through prospective and retrospective programs.
• Develop multi-year roadmap for risk capture, documentation improvement, and coding optimization.
• Partner with provider groups and leaders to embed risk workflows into care delivery.
• Oversee coding programs including chart review, CDI, education, and audits.
• Ensure adherence to ICD-10, CMS-HCC, and state-specific risk methodologies.
• Standardize best practices across networks and maintain audit readiness.
• Model RAF impact with finance and actuarial teams.

Skills

Risk adjustment expertise

CMS-HCC knowledge

ICD-10 proficiency

Regulatory compliance

Leadership experience

Tools

Chart review tools

CDI processes

Analytics tools

Job description

UnitedHealth Group's Optum NY in New York, NY seeks an Executive Director of Risk Adjustment to lead enterprise-wide risk adjustment programs across provider networks, ensuring accurate, compliant and sustainable RAF performance.

This leader partners with provider organizations, clinical leadership, coding teams, and analytics to embed risk capture into workflows while maintaining audit readiness and regulatory compliance.