7-10 years in healthcare operations, risk adjustment, or managed care, with 4-5 years in leadership roles.
Experience leading large-scale, cross-functional risk adjustment programs across multiple markets.
Ability to develop organizational strategy and drive performance improvement initiatives.
Advanced knowledge of risk adjustment, HCC coding, and regulatory requirements (CMS, NCQA).
Strong expertise in program design and provider performance optimization.
Exceptional leadership and project management skills for managing multi-level teams.
Strong analytical and communication skills, capable of influencing executive stakeholders.
Responsibilities
Provide strategic leadership for multi-market risk adjustment and population health operations.
Lead enterprise-wide risk adjustment initiatives from strategy to execution, including chart reviews and coding optimization.
Establish operational workflows and best practices to enhance efficiency and coding accuracy.
Oversee program performance, resource allocation, and budget recommendations to drive outcomes.
Analyze performance metrics to identify trends and develop strategic action plans.
Collaborate with clinical and operational stakeholders to align initiatives and resolve issues.
Ensure compliance with regulatory standards and oversee audits and quality assurance.
Benefits
Hybrid work model with flexibility to work from home and travel to provider offices.
Opportunity to lead impactful, enterprise-wide initiatives in a dynamic healthcare environment.
Full Job Description
Sr. Manager - Risk Adjustment - Inland Empire/San Diego
Department: Quality - Risk Adjustment
Employment Type: Full Time
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To: Nallammai Vijayakumar
Compensation: $120,000 - $140,000 / year
Description
The Senior Manager, Risk Adjustment Programs is responsible for leading enterprise-wide and cross-regional risk adjustment initiatives with accountability for strategic direction, program design, operational oversight, and organizational performance. This position oversees multiple markets (San Diego/Inland Empire), provider networks, and large-scale initiatives while serving as a subject matter expert in risk adjustment strategy, coding optimization, provider engagement, and population health performance. The Senior Manager develops and drives programs that extend beyond individual regions and have broad organizational impact.
What You'll Do
Provide strategic leadership and oversight of multi-market risk adjustment and population health operations, managing Manager-level leaders and multi-layered teams while driving talent development, performance management, accountability, and operational consistency.
Lead enterprise-wide and cross-regional risk adjustment initiatives from strategy through execution, including retrospective chart reviews, provider outreach, coding optimization, annual wellness visits, and documentation improvement programs.
Establish and standardize operational workflows, governance structures, policies, and best practices to improve scalability, efficiency, coding accuracy, and performance across markets and provider networks.
Oversee program performance, resource allocation, capacity planning, vendor relationships, and budget recommendations while driving outcomes related to RAF performance, documentation integrity, coding accuracy, and productivity.
Analyze operational and financial performance metrics to identify trends, gaps, and improvement opportunities; develop strategic action plans and provide recommendations to executive leadership.
Partner with clinical, operational, provider, health plan, and executive stakeholders to align enterprise initiatives, strengthen provider engagement, resolve complex operational issues, and advance organizational objectives.
Ensure regulatory and compliance standards are met across all programs, including CMS, NCQA, and DMHC requirements, overseeing audits, chart reviews, quality assurance, and corrective action plans.
Other duties as assigned.
Qualifications
7-10 years of healthcare operations, risk adjustment, population health, or managed care experience, including 4-5 years of progressive leadership experience overseeing managers or multi-layered teams.
Demonstrated experience leading large-scale, cross-functional risk adjustment programs and enterprise-wide initiatives across multiple markets or business units.
Proven ability to develop organizational strategy, drive performance improvement, and lead complex operational initiatives.
Advanced expertise in risk adjustment, HCC coding, value-based care programs, and applicable regulatory requirements, including CMS and NCQA.
Strong subject matter expertise in risk adjustment strategy, program design, provider performance optimization, and operational excellence.
Exceptional leadership, project management, and change management skills, with experience managing multi-level teams and enterprise-scale initiatives.
Strong analytical, communication, presentation, and relationship management skills, with the ability to influence executive stakeholders and drive data-informed decisions.
Preferred certifications: CRC, CPC, CCS, RHIA, RHIT, or equivalent.
Environmental Job Requirements and Working Conditions
This is a full-time, hybrid position, where you will be expected to work from home and also travel to provider office throughout Inland Empire and San Diego.
The national target compensation for this position is $120,000 - $140,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
