Director, Risk Adjustment Prospective Programs

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an
authentic experience!

Reporting to the Vice President, Risk Adjustment, the Director of Risk Adjustment Prospective Programs is a strategic leader responsible for implementing, operationalizing, and optimizing the health plan's point-of-care, concurrent, and forward-looking risk adjustment initiatives. Unlike traditional retrospective "chart chasing," this role focuses entirely on prospective interventions, capturing accurate member health acuity before or during a provider encounter. This position executes the enterprise strategy and converts it into scalable workflows, controls, KPIs, EHR integrations, and provider-facing tools that reduce friction for independent clinicians and delegated IPAs.

The primary mandate of this position is to ensure the plan's risk adjustment program is a proactive, clinically driven model. Operating within a network structure comprised of independent, Fee-for-Service (FFS) practices and delegated Independent Physician Associations (IPAs), this Director leads programs such as in-home and virtual assessments, pre-visit suspecting, point-of-care documentation supports, and concurrent validation. This leader ensures chronic conditions are documented accurately to CMS compliance standards in real time, driving revenue accuracy and improving proactive clinical care management.

Commitment to Quality:
The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

• Prospective Program Design & Execution:
• Point-of-Care Interventions: Lead the implementation, optimization, and scalability of the health plan's prospective assessment programs, ensuring that historical chronic conditions and suspected HCC gaps are delivered cleanly to providers at the time of a member's visit
• In-Home Assessment Management: Oversee the strategy, vendor selection, and performance metrics for the plan’s in-home health assessment (IHA) and virtual assessment campaigns for hard-to-reach or disengaged members. Ensure documentation meets compliance standards and integrated with care management
• Workflow Burden Reduction:
  Minimize administrative friction for independent clinicians by building EHR smart-phrases, discrete macros, and pre-visit planning summaries that easily integrate into standard primary care workflows
• Provider Engagement & Clinical Advocacy:
• Value-Based FFS
  
  Incentives:
  
  Partner with Contracting and Provider Relations to design and manage prospective "Per-Assessment" incentive programs or quality bonus structures that compensate independent FFS doctors for taking the extra time to complete rigorous documentation
• Peer-to-Peer Training: Oversee the development of tailored prospective education modules for independent clinics on compliance documentation standards (e.g., CMS M.E.A.T (Monitor, Evaluate, Assess, Treat) criteria) at the point of patient encounter
• IPA Coordination:
  Collaborate with…