Senior Risk Adjustment Ops & Quality Improvement Lead

Clever Care Health Plan; Huntington Beach (CA); Hybrid; USD 127,000 - 160,000; Full time

Job summary

Clever Care Health Plan is seeking a Senior Manager to lead risk adjustment operations and performance improvement for Medicare Advantage plans in a hybrid work model based in Huntington Beach. You will oversee Stars, HEDIS, CAHPS initiatives, and RAF activities to boost quality outcomes, coding accuracy, and member experience.

Responsibilities include cross-functional program execution, analytics-driven interventions, provider performance management, and vendor oversight to ensure regulatory

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, or related field.
• 5–8 years in Medicare Advantage, managed care, or risk adjustment.
• 3+ years leading teams or operational programs.

Responsibilities

• Lead operational execution of Stars, HEDIS, CAHPS, and RAF programs.
• Develop annual workplans and performance goals.
• Manage cross-functional implementation and provider engagement.
• Oversee dashboards, scorecards, and performance reports.
• Ensure CMS/NCQA compliance and audit readiness.
• Oversee vendor performance and data quality improvements.

Skills

Leadership

Project management

Analytics

Communication

Provider engagement

Excel

Power BI

Education

Bachelor's degree in Healthcare Administration

Bachelor's degree in Business Administration

Tools

Excel

Power BI

Job description

Clever Care Health Plan is seeking a Senior Manager to lead risk adjustment operations and performance improvement for Medicare Advantage plans in a hybrid work model based in Huntington Beach. You will oversee Stars, HEDIS, CAHPS initiatives, and RAF activities to boost quality outcomes, coding accuracy, and member experience.

Responsibilities include cross-functional program execution, analytics-driven interventions, provider performance management, and vendor oversight to ensure regulatory