Senior Risk Adjustment Leader - RADV & Analytics

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 130,000 - 200,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a Sr. Manager, Risk Adjustment to lead risk adjustment operations across Medicare Advantage, Marketplace, and affiliated plans.

You will guide strategy, ensure regulatory compliance, and drive data-driven improvements in risk capture and score accuracy. The role requires cross-functional collaboration with providers, vendors, and internal teams, plus oversight of reporting tools, analytics, and forecasting to support enterprise-level decisions

Qualifications

• Bachelor's degree required; equivalent combination of education and relevant experience may be considered.
• Minimum 5-7 years of progressive experience in Risk Adjustment with CMS-HCC and HHS-HCC program operations is expected.

Responsibilities

• Lead risk adjustment strategy and operations across all lines of business.
• Stay current on CMS-HCC and RxHCC model updates and methodologies.
• Manage department staff and cross-functional teams on RADV readiness and provider education.
• Build and manage risk adjustment reporting dashboards and BI tools.
• Conduct data gap analyses to improve risk capture and data completeness.
• Collaborate with providers, vendors, and internal teams to improve documentation and coding quality.
• Oversee vendor relationships, contracts, and regulatory compliance.
• Translate CMS/HHS guidance into actionable operational processes.
• Lead RADV audit preparedness and ensure audit readiness across programs.
• Perform analytics, benchmarking, and forecasting to assess performance.

Skills

Leadership

Vendor management

Regulatory compliance

Analytical thinking

Stakeholder engagement

Education

Bachelor's degree

Tools

SQL

Excel

Word

Access

Job description

Imperial Health Plan of California, Inc. is seeking a Sr. Manager, Risk Adjustment to lead risk adjustment operations across Medicare Advantage, Marketplace, and affiliated plans.

You will guide strategy, ensure regulatory compliance, and drive data-driven improvements in risk capture and score accuracy. The role requires cross-functional collaboration with providers, vendors, and internal teams, plus oversight of reporting tools, analytics, and forecasting to support enterprise-level decisions