Director of Risk Adjustment & Quality Record Retrieval

** Become a part of our caring community*
* The Director of Risk Adjustment& Quality Record Retrieval is responsible for leading front-line record retrieval operations that support several top strategic priorities for Humana. These high-profile priorities include Risk Adjustment's Chart Review program, Risk Adjustment internal and external audits (e.g., CMS Risk Adjustment Data Validation [RADV] audits), quality initiatives such as HEDIS, and other projects as needed. The Director works collaboratively across the enterprise to ensure retrieval processes and outcomes are optimized and effectively communicated.

The Director of Risk Adjustment & Quality Record Retrieval leads a large-scale operation of 300 associates across the country focused on the successful retrieval of medical records for critical internal and external Risk Adjustment and Quality priorities. Humana's retrieval strategy is multi-faceted, leveraging both internal and external channels; this Director will be specifically responsible for driving all operational activities and strategies tied to Humana's internal field retrieval function.

** Key expectations and responsibilities of this role include:*
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** Enterprise Leadership & Workforce Management**  - Lead and develop a national, fully remote workforce of 300 teammates, including frontline staff, supervisors, and managers. Establish organizational structure, performance management frameworks, staffing models, and budget oversight to ensure a high-performing and scalable operation.

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** Operations Management**  - Oversee end-to-end retrieval operations, driving performance through data-informed decision-making, goal monitoring, and operational accountability. Identify trends, gaps, and barriers to optimize outcomes, improve efficiency, and effectively manage escalations.

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** Innovation**  - Drive continuous improvement through the evaluation and enhancement of processes, technology, and provider engagement strategies. Identify opportunities to advance program performance, efficiency, and experience while remaining informed of industry trends, CMS changes, and emerging capabilities.

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** Change Management**  - Lead the implementation of operational, technology, regulatory, and organizational changes across a large, distributed workforce. Develop and execute change strategies that drive adoption, minimize disruption, and ensure successful delivery of enterprise initiatives through effective communication, training, and stakeholder engagement.

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** Collaboration**  - Build trusted partnerships across Risk Adjustment, Stars, Interoperability, Market leadership, and other key stakeholders to align priorities, resolve issues, and ensure effective communication, escalation management, and execution of enterprise objectives.

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** Engagement & Culture**  - Foster a culture of inclusion, accountability, collaboration, and continuous learning while driving employee engagement, retention, and professional development. Create an environment focused on quality, outcomes, and teammate growth.

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** Compliance & Risk Management**  - Promote a culture of compliance and ensure adherence to privacy, regulatory, and internal policy requirements. Partner with Compliance and Legal teams to mitigate operational risk, maintain audit readiness, and support effective governance.

** Use your skills to make an impact*
* ** Required Qualifications*
* + 5+ years of leadership experience, including people leadership and large-scale initiatives

+ 3+ years of experience managing large operational processes with high-stakes outcomes

+ Demonstrated success leading teams and delivering results in dynamic, evolving business environments

+ Track record of driving measurable results through process improvement and data-driven insights

+ Best-in-class communication skills at all levels; experience articulating complex operations to senior levels (VP+) of leadership

+ Comfort making quick decisions based on quantitative and qualitative insights

+ Experience cultivating trust and collaboration across a matrixed organization

** Preferred Qualifications*
* + Domain knowledge of Risk Adjustment, Stars, and Medicaid

+ Experience…