Hiring: Director, Risk Adjustment Strategies and Initiatives Company: L.A. Care Health Plan Location: Los Angeles, CA Job Posted Time: 2026-09-16 21:12:25 Target Skills & Keywords : Clinical Documentation, ICD-10, Medicaid, Medicare, Microsoft Office, Project Management About the job Experience: •At least 8 years of experience in risk adjustment, and strong knowledge of Centers for Medicare and Medicaid Services (CMS) Risk Adjustment and ICD-10 coding requirements and regulations. •At least 6 years of leadership and management experience. •At least 5 years of experience in the healthcare setting. Required Skills: •Lead and oversee bringing forward and developing/implementing tools or other activities to support organizational goals. Collaborate with other staff, as necessary, to finalize initiatives and provide training to internal and external stakeholders as needed. •This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. •Lead and oversee supporting the organizational, management and development of risk adjustment programs for L.A. Care’s risk adjusting lines of business (LOB). Conduct strategic planning to utilize resources to meet current and future departmental and Enterprise-wide goals. •Maintain and assess the risk adjustment and Medicare STAR landscape to identify opportunities and determine program needs, tools, etc. to support the organization’s objectives, physicians and other partners in these programs in understanding the risk adjustment payment model and Medicare STAR program. •Lead and oversee bringing forward and developing/ implementing tools or other activities to support organizational goals. Collaborate with other staff, as necessary, to finalize initiatives and provide internal, provider and other training, as needed. •Manage risk adjustment vendors (chart retrieval, coding, suspecting, analytics tools, provider education) including performance SLAs and outcomes. Identifies, negotiate with and manage external vendors to ensure deliverables are met in a timely manner. Manage budgets and resources effectively. •Partners with analytics teams to identify opportunities through data mining, predictive suspecting, and performance segmentation. Translate complex data into actionable recommendations and executive-level updates. •Lead discussions on policy operationalization and oversee key policy perspective sharing. Prepare briefings, reports, consultation documents and presentations that clearly articulate L.A. Care's regulatory position and policy. Develops regulatory position and policy based on research and evidence. Qualifications: •Master's Degree in Business Administration or Healthcare Management or Related Field •The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. •L.A. Care Offers a Wide Range Of Benefits Including Paid Time Off (PTO) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!