Risk Adjustment Director

We have an opportunity to join the Alliance as the Risk Adjustment Director leading the Risk Adjustment Department. 

This position can be located in one of our service counties (Mariposa, Merced, Monterey, Santa Cruz, or San Benito) or remotely in California with expected travel to Alliance service area(s) once a quarter. Must reside in California upon hire. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Chief Financial Officer, you will:

• Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance’s Risk Adjustment Department functions
• Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations
• Direct, manage, and supervise Risk Adjustment Department staff

ABOUT THE TEAM

The Finance Division acts as the guardian of the Alliance’s financial health. We track the pulse of the organization by analyzing budgets, forecasting future performance, and navigating the ever-changing economic and political landscape. To keep the Alliance financially strong and secure, we wear several hats and partner with every department in the organization to translate fiscal data into insights and action. From managing funds to risk management and compliance, we ensure the Alliance’s responsible use of public funds.

This role will lead Medicare DSNP Risk Adjustment strategy and execution, overseeing a high-performing team of three. Current DSNP membership is approximately 800, with projected growth to 2,000 by year-end. While this is a leadership position, the current stage of the program requires a hands-on approach. The Director will be responsible for both guiding the strategic direction and directly supporting key operational initiatives to ensure program stability and scalability. This leader will work closely with cross-functional stakeholders to drive alignment, educate on program priorities, and advance key initiatives. Success in this role will require strong collaboration and influence to accelerate progress and embed risk adjustment best practices across the organization.

As the DSNP program evolves, this role will play a pivotal leadership role in scaling capabilities across physician engagement, cross-functional program coordination, and operational infrastructure. The scope and complexity of responsibilities will grow in alignment with membership expansion and organizational priorities. 

THE IDEAL CANDIDATE 

• A motivated and seasoned leader in the managed care industry, with expertise in risk adjustments
• Excellent communication skills, with strength in building relationships and partnering with cross-functional teams.
• Champion accountability across the organization
• Experience in overseeing the Medicare Risk Adjustment life cycle
• Strong data and analytical skills, including SQL, dashboarding, and reporting
• Be invested in staff development and empowering teams to do their best work
• Medi-Cal experience is a plus
• IPA/Medical Group experience highly desired

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here. 

• Knowledge of:
  • The managed care industry and of Medicare health insurance payment methodologies
  • Medicare (Hierarchical Condition Categories) risk adjustment models
  • Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations 
  • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
  • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
  • Methods and techniques of valuating for physician and inpatient and outpatient hospital costs
• Ability to:
  • Demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
  • Perform complex analysis related to rate negotiations, health care cost reports, and determination of rates for hospitals, clinics, long-term care facilities, allied health services, professional services, and specialist services
  • Develop, plan, organize, and direct finance programs and activities that are complex in nature and regional in scope
  • Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues
  • Demonstrate a collaborative management style, build rapport, demonstrate excellent public relations skills, and effectively manage internal and external business relationships
• Education and Experience:
  • Bachelor’s degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field 
  • A minimum of ten years of experience in healthcare finance or analytics, which included a minimum of five years of experience with Medicare risk adjustment processes, a minimum of two years of experience related to Medicare Managed Care Programs, and a minimum of three years of supervisory experience (a Master’s degree may substitute for two years of general healthcare finance or analytics experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

COMPENSATION INFORMATION

• Zone 1 Pay Range: $210,000 - $250,000
  Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  
  
• Zone 2 Pay Range: $200,000 - $235,000
  Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas listed. You can reach out to [email protected], and a member from our Talent Acquisition team will be in touch.

The hiring ranges represent a good‑faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).