Head of Prospective Risk Adjustment Initiatives

Inland Empire Health Plans; Rancho Cucamonga (CA); On-site; USD 150,000 - 230,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, and vision insurance

Life, disability insurance

Career development

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) plan

Paid life insurance

Pet care insurance

Job summary

Inland Empire Health Plans (IEHP) seeks a Director of Risk Adjustment Prospective Programs to lead the design and execution of proactive risk adjustment initiatives across point-of-care, in-home, and concurrent settings. You will translate enterprise strategy into scalable workflows, KPIs, and provider-facing tools within a network of independent physicians and IPAs.

The role emphasizes CMS-compliant documentation, revenue accuracy, and collaboration with clinics, vendors, and internal

Qualifications

• Eight years of progressive experience in healthcare managed care or risk adjustment operations.
• Five years in leadership managing teams, projects, and cross-functional initiatives.
• CRC or CPC certification required; RN/NP license preferred in California.

Responsibilities

• Lead prospective risk adjustment programs across in-home, point-of-care, and concurrent activities.
• Develop scalable workflows, KPIs, and provider-facing tools for risk adjustment.
• Ensure CMS-compliant documentation and revenue accuracy in real time.
• Collaborate with independent physicians, IPAs, and vendors to drive adoption.

Skills

Strategic leadership

Risk adjustment

Program management

Change management

Stakeholder facilitation

Data literacy

Communication

Analytics tools

Vendor management

Cross-functional collaboration

Education

Bachelor's degree in nursing, public health, healthcare administration or related field

Master's degree in nursing, public health, healthcare administration or related field preferred

CRC or CPC certification

RN/NP license preferred

Tools

Epic

Athena

eClinicalWorks

Job description

Inland Empire Health Plans (IEHP) seeks a Director of Risk Adjustment Prospective Programs to lead the design and execution of proactive risk adjustment initiatives across point-of-care, in-home, and concurrent settings. You will translate enterprise strategy into scalable workflows, KPIs, and provider-facing tools within a network of independent physicians and IPAs.

The role emphasizes CMS-compliant documentation, revenue accuracy, and collaboration with clinics, vendors, and internal