Senior Director, Risk Adjustment & Population Health

Astrana Health Management; Alhambra (CA); Remoto; USD 160.000 - 195.000; Tempo pieno

Descrizione del lavoro

Astrana Health seeks a Sr. Director of Risk Adjustment to lead risk adjustment, clinical documentation improvement, provider engagement, and population health strategies. This leader will guide Senior Managers, Managers, and teams, translating enterprise priorities into measurable results.

The role focuses on innovation, operational excellence, and value‑based care, driving compliance, revenue integrity, and performance across markets. Remote work with travel in the US is required.

Competenze

• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Health Information Management, or related field required.
• At least 10 years of healthcare operations, risk adjustment, managed care, or population health experience.
• At least 5 years of progressive leadership experience managing multiple teams or programs.
• One or more of the following certifications preferred: CRC, CPC, CCS, RHIA, RHIT.
• Expert knowledge of CMS-HCC, Medicare Advantage, ACA, Medicaid, and value‑based reimbursement methodologies.

Mansioni

• Develop and execute enterprise-wide risk adjustment and documentation improvement strategies aligned with organizational and value-based care objectives.
• Establish departmental goals, KPIs, and operational plans driving risk capture, coding accuracy, provider engagement, and financial performance.
• Identify opportunities to enhance revenue integrity, operational efficiency, and program effectiveness through innovative solutions and data‑driven decision making.
• Provide leadership on regulatory requirements, risk adjustment methodologies, and industry best practices.
• Provide oversight of risk adjustment, coding, provider education, documentation improvement, retrospective review, and prospective outreach programs.
• Ensure consistent implementation of standards, workflows, and performance expectations across markets and business units.
• Lead cross‑functional initiatives involving clinical services, provider operations, analytics, quality, compliance, and finance teams.
• Monitor program outcomes and implement strategic improvements to maximize organizational performance.
• Build and maintain strategic relationships with executive leadership, provider groups, health plans, vendors, and external stakeholders.
• Present performance and strategic recommendations to senior leadership and oversee vendor management activities.

Conoscenze

Leadership

Strategic planning

Stakeholder management

Data analysis

Regulatory knowledge

Communication

Change management

Formazione

Bachelor's degree in Healthcare Administration

Master's degree preferred

Descrizione del lavoro

Astrana Health seeks a Sr. Director of Risk Adjustment to lead risk adjustment, clinical documentation improvement, provider engagement, and population health strategies. This leader will guide Senior Managers, Managers, and teams, translating enterprise priorities into measurable results.

The role focuses on innovation, operational excellence, and value‑based care, driving compliance, revenue integrity, and performance across markets. Remote work with travel in the US is required.