Strategic Director, Prospective Risk Adjustment Programs

IEHP; Rancho Cucamonga (CA); Hybrid; USD 123,000 - 204,000; Full time

Benefits offered by this job

Competitive salary

State of the art fitness center on‑sit

Medical Insurance with Dental and Vis

Life, short‑term, and long‑term disabi

Career advancement opportunities and

Job summary

IEHP in Rancho Cucamonga, CA is seeking a Director of Risk Adjustment Prospective Programs to lead proactive risk adjustment initiatives across the plan. You will design and operationalize point-of-care, in-home, and concurrent programs, and translate strategy into scalable workflows and provider tools.

Reporting to the VP Risk Adjustment, you will drive CMS-compliant documentation, enhance data quality, and collaborate with independent networks to optimize revenue integrity and patient care.

Qualifications

• Minimum eight years in healthcare managed care or risk adjustment operations.
• Five+ years in leadership managing teams and cross-functional projects.
• Experience improving documentation capture and submission integrity via EHR integrations.

Responsibilities

• Lead prospective risk adjustment programs (point-of-care, in-home, concurrent).
• Operationalize workflows, controls, KPIs, and provider-facing tools.
• Ensure CMS-compliant documentation and real-time accuracy in risk adjustment.

Skills

Exceptional communicator

Data literacy

Excel/BI tools

Stakeholder facilitation

Cross-functional collaboration

Education

Bachelor’s degree in nursing / public health / healthcare administration

Master’s degree in nursing / public health / healthcare administration (preferred)

CRC or CPC certification (AAPC or AHIMA)

CDI certification preferred (e.g., CCDS)

RN or NP licensed in California preferred

Tools

Epic

Athena

eClinicalWorks

Job description

IEHP in Rancho Cucamonga, CA is seeking a Director of Risk Adjustment Prospective Programs to lead proactive risk adjustment initiatives across the plan. You will design and operationalize point-of-care, in-home, and concurrent programs, and translate strategy into scalable workflows and provider tools.

Reporting to the VP Risk Adjustment, you will drive CMS-compliant documentation, enhance data quality, and collaborate with independent networks to optimize revenue integrity and patient care.