Senior Director Risk Adjustment

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Sr. Director provides enterprise leadership to design, standardize, and continuously improve the end-to-end operating model across HEDIS and Risk Adjustment. This role drives sustained improvements in data collection, data processing, encounter creation and management, submission controls, reconciliation, and audit readiness to ensure performance outcomes are reliable, defensible, and scalable across all lines of business.

The Sr. Director ensures that execution across internal teams, technology partners, analytics, finance, and external vendors is aligned and coordinated, with clear ownership, disciplined governance, and consistent performance expectations. Through integrated leadership and cross functional prioritization, this role strengthens operational maturity, reduces rework, and enables proactive management of performance, compliance, and financial risk. Performs other duties as assigned.

• End to End System Leadership
  • Provide integrated leadership across HEDIS and Risk Adjustment to ensure the full lifecycle—from data intake and processing through encounter management, submission, reconciliation, and audit—is standardized, controlled, and continuously improved.
  • Ensure program execution operates as a coordinated system with clear ownership, predictable outcomes, and scalable practices across all lines of business.
• Data, Encounter, and Process Integrity
  • Drive sustained improvements in data collection, processing, and validation, including claims-to-encounter logic, submission controls, reconciliation routines, and audit traceability.
  • Partner with Technology, Data, and Analytics teams to strengthen upstream controls, reduce rework, and increase confidence in performance and financial outputs.
• Governance, Compliance, and Audit Readiness
  • Establish and maintain governance structures that ensure regulatory compliance, audit readiness, and defensible outcomes across HEDIS and Risk Adjustment.
  • Oversee preparation and response for HEDIS audits, RADV, IVA, and related regulatory reviews, ensuring issues are identified early and addressed through durable solutions.
• Vendor and Partner Accountability
  • Own the end-to-end vendor operating model for Risk Adjustment and related support services.
  • Define scope, performance expectations, handoffs, and escalation paths, and ensure vendor contributions are fully integrated into Medica's operating model and performance standards.
• Cross Functional Integration & Prioritization
  • Serve as the primary integrator across Quality, Performance Outcomes, Technology, Data, Analytics, Finance, Actuarial, Provider Quality, and external partners.
  • Align priorities, timelines, and resources to ensure coordinated execution and reduce operational friction across complex dependencies.
• Enterprise Performance Enablement
  • Protect enterprise outcomes by stabilizing execution, improving predictability, and reducing regulatory, financial, and reputational risk.
  • Enable senior leadership to focus on strategy and long-term organizational maturity by ensuring day-to-day system performance is well governed and proactively managed.
• Leadership
  • Promote a positive work environment and set an atmosphere of open communication and feedback.
  • Serve as a leader within the division and to the organization, working to ensure collaboration and teamwork across all teams to achieve objectives.
  • Ensure alignment with and effective execution of strategies to achieve team key performance indicators as well as Medica's overall objectives.
  • Fo…