Head of Risk Adjustment Strategy & Initiatives

L.A. Care; Los Angeles (CA); Hybrid; USD 150,000 - 254,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan is seeking a Director, Risk Adjustment Strategies and Initiatives in Los Angeles to lead enterprise risk adjustment programs, AWEs, and Medicare STAR initiatives with cross-functional teams.

Responsibilities include developing strategic plans, driving program governance, ensuring regulatory compliance, coaching staff, managing vendors, and delivering timely data-driven insights to support revenue integrity and improved performance across lines of business.

Qualifications

• 8+ years of risk adjustment experience and strong CMS ICD-10 knowledge.
• Leadership experience managing teams and cross-functional initiatives.
• Experience with ACA/Medicare STAR and regulatory submissions.

Responsibilities

• Lead risk adjustment programs across L.A. Care’s lines of business.
• Develop governance, timelines, and reporting for risk initiatives.
• Collaborate with vendors and internal stakeholders to improve coding and documentation.

Skills

Risk adjustment

Leadership

Data analysis

Regulatory knowledge

CMS ICD-10

Education

Bachelor's Degree in Business Administration

Master's Degree in Healthcare Management

Tools

MS Office

Job description

L.A. Care Health Plan is seeking a Director, Risk Adjustment Strategies and Initiatives in Los Angeles to lead enterprise risk adjustment programs, AWEs, and Medicare STAR initiatives with cross-functional teams.

Responsibilities include developing strategic plans, driving program governance, ensuring regulatory compliance, coaching staff, managing vendors, and delivering timely data-driven insights to support revenue integrity and improved performance across lines of business.