Medical Director, Risk Adjustment | Hartford HealthCareHartford, ConnecticutHartford HealthCare is seeking a Board Certified Physician to join our Clinical Integration team. The Medical Director, Risk Adjustment is a practicing physician who provides clinical leadership and oversight for the organization's risk adjustment, clinical documentation integrity, and clinician education initiatives. This role partners closely with Quality, Clinical Integration, Population Health, Revenue Cycle, Health Economics, and Operational leadership to ensure accurate and compliant documentation of patient complexity, severity of illness, and chronic disease burden across value-based care programs.
The Medical Director serves as the physician champion for risk adjustment, promoting evidence-based documentation practices, supporting clinician engagement, and ensuring the accurate representation of patient populations in Medicare Advantage, MSSP, Commercial Value-Based Contracts, and other risk-adjusted payment models.
Position HighlightsStrategic Leadership
- Provide physician leadership for all risk adjustment and documentation improvement initiatives.
- Develop and support organizational strategies to improve risk score accuracy, condition recapture rates, documentation quality, and compliance.
- Participate in the development of annual risk adjustment goals, metrics, and performance improvement plans.
- Advise leadership on regulatory changes, CMS guidelines, and industry best practices impacting risk adjustment programs.
- Support value-based care initiatives by ensuring accurate representation of patient complexity and clinical burden.
Physician Engagement & Education
- Serve as the physician champion for risk adjustment and documentation excellence.
- Lead clinician-facing education regarding HCC coding, documentation requirements, chronic disease management, and risk-adjusted payment methodologies.
- Present practice-level performance data and opportunities for improvement to physicians and leadership teams.
- Partner with Clinician Integration Managers and Risk Adjustment Educators to develop educational content and communication strategies.
- Facilitate discussions with physicians regarding coding opportunities, documentation clarification, and workflow optimization.
Clinical Documentation & Coding Oversight
- Provide clinical oversight and guidance on documentation integrity initiatives.
- Review documentation and coding trends to identify opportunities for improvement.
- Assist in the resolution of complex clinical validation and documentation questions.
- Support development of compliant documentation standards consistent with CMS regulations and organizational policies.
- Collaborate with coding and CDI professionals to ensure documentation accurately reflects patient complexity and care delivery.
Quality, Analytics & Performance Improvement
- Review risk adjustment performance metrics, RAF trends, prevalence reports, suspect condition capture rates, and clinician-level performance dashboards.
- Assist with identification of high-impact improvement opportunities.
- Partner with Health Economics and Analytics teams to interpret clinical performance data.
- Support audits, data validation, and quality assurance activities.
Compliance & Regulatory Oversight
- Promote compliance with CMS, Medicare Advantage, MSSP, and payer-specific documentation requirements.
- Support internal and external audit activities.
- Ensure educational and documentation initiatives align with regulatory standards and organizational policies.
- Participate in monitoring activities to identify and mitigate compliance risks.
Comprehensive Benefits- Generous paid time off + company holidays
- CME allowance + dedicated CME time
- Reimbursement for licenses, certifications, and professional dues
- 401(k) with strong employer match
- Family-focused benefits including backup childcare support
- Voluntary benefits: tuition programs, insurance options (home, auto, pet), legal services, identity protection, and more
Apply TodayPatti Lowicki
Senior Director, Provider Recruitment and Integration
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[email protected]📱 Call/Text: (860) 558-6591
Qualifications:- Current unrestricted Connecticut medical license
- Board certification in a recognized specialty
- Active clinical practice maintained throughout employment
- Minimum 5 years of clinical practice experience
- Experience in population health, quality improvement, or value-based care initiatives
- Demonstrated leadership experience with physicians or multidisciplinary teams
