Director, Risk Adjustment Products

Director, Risk Adjustment Products

Director II - Product Management

UST Health Proof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well‑being. With our commitment to simplicity, honesty, and leadership, we navigate challenges to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4,000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people‑centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with technical and operations teams, both internally and externally, to create innovative solutions that deliver measurable impact for our customers. This is a leadership role where you will pair your product development and people management expertise to mentor a high‑performance team.

• Define multi‑year plans aligned to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement.
• Identify and prioritize use cases that leverage AI/ML and real‑time data signals to surface high‑impact suspects and coding opportunities.
• Drive innovation leveraging interoperability standards (FHIR, HL7, APIs) to enable seamless enablement with EHRs, care management platforms, and third‑party integrations.
• Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions.
• Lead the end‑to‑end product lifecycle, including ideation, requirements gathering, development, launch, and post‑launch optimization.
• Work closely with Engineering and Data Science to build predictive models and real‑time data pipelines that power suspecting and concurrent workflows.
• Ensure products are clinically relevant, user‑centric, and integrated into existing payer and provider workflows through interoperability integrations.
• Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and concurrent coding capture and correction rates.
• Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption).
• Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk‑bearing provider groups).
• Lead customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and concurrent coding needs.
• Present product strategy and roadmap updates to executive stakeholders and client advisory boards.
• Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).
• Implement and monitor processes that ensure defensibility of all outputs, documentation standards, and audit trails.
• Design and embed audit readiness into product workflows, ensuring all activities are traceable, evidence‑backed, and aligned with CMS documentation requirements.
• Provide strategic recommendations and decision frameworks when trade‑offs between revenue, compliance, and user experience arise.
• Build, lead, and coach a team of Product Managers working across different facets within prospective and concurrent solutions.
• Provide mentorship, performance management, and career development aligned with leadership principles and growth culture.
• Establish best‑in‑class product practices and instill a culture of experimentation, feedback, and continuous learning.
• Support resourcing and hiring plans as product needs evolve and grow.

• Bachelor’s degree in business or technical field required;
  Master’s degree in business or technical field preferred.
• 10+ years of Risk Adjustment product…