Sr. Director - Risk Adjustment

Department:
Quality
- Risk Adjustment

Employment Type:

Full Time

Location:

1668 S. Garfield Ave. 2nd Floor, Alhambra, CA 91801

Reporting To:
Nallammai Vijayakumar

Compensation: $160,000 - $195,000 / year

We are seeking a strategic and dynamic leader to drive the organization’s risk adjustment, clinical documentation improvement, provider engagement, and population health strategies. This role will lead multiple layers of leadership, including Senior Managers, Managers, and their teams, while translating enterprise priorities into meaningful operational results. The ideal leader will build and develop high‑performing teams, cultivate strong leadership talent, and foster collaboration across the organization.

With a focus on innovation, operational excellence, and value‑based care, this individual will play a key role in advancing risk adjustment accuracy, regulatory compliance, provider performance, and overall population health outcomes.

Our Values:
Put Patients First | Empower Entrepreneurial Provider and Care Teams | Operate with Integrity & Excellence | Be Innovative | Work As One Team

• Develop and execute enterprise-wide risk adjustment and documentation improvement strategies aligned with organizational and value-based care objectives.
• Establish departmental goals, key performance indicators (KPIs), and operational plans that drive measurable improvements in risk capture, coding accuracy, provider engagement, and financial performance.
• Identify opportunities to enhance revenue integrity, operational efficiency, and program effectiveness through innovative solutions and data‑driven decision making.
• Provide leadership and guidance on emerging regulatory requirements, risk adjustment methodologies, and industry best practices.

• Provide oversight of risk adjustment, coding, provider education, documentation improvement, retrospective review, and prospective outreach programs.
• Ensure consistent implementation of operational standards, workflows, and performance expectations across all markets and business units.
• Lead cross‑functional initiatives involving clinical services, provider operations, analytics, quality, compliance, and finance teams.
• Monitor program outcomes and implement strategic improvements to maximize organizational performance.

• Accountable for achievement of risk adjustment, quality, productivity, compliance, and financial performance goals.
• Develop and manage departmental budgets, workforce planning, resource allocation, and vendor expenditures.
• Evaluate operational trends, performance metrics, and financial results to identify opportunities for growth and process improvement.
• Implement corrective action plans when performance objectives are not being achieved.

• Build and maintain strategic relationships with executive leadership, provider groups, health plans, vendors, and external stakeholders.
• Partner with providers and operational leaders to support documentation excellence, coding accuracy, and value‑based care success.
• Present business performance, strategic recommendations, and operational results to senior leadership and executive stakeholders.
• Oversee vendor management activities, including performance monitoring, contract compliance, and service delivery expectations.

• Ensure organizational compliance with CMS, NCQA, DMHC, HHS, and other applicable federal, state, and health plan requirements.
• Oversee internal monitoring, audits, and regulatory review activities related to risk adjustment and documentation practices.
• Collaborate with compliance and quality teams to implement corrective…