Director, Risk Adjustment Prospective Programs

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.

• 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

• A minimum of eight (8) years of progressive experience in healthcare managed care or risk adjustment operations, with a distinct, heavy emphasis on executing prospective (point‑of‑care, in‑home, or concurrent) programs. At least five (5) years of leadership and management experience leading teams, projects, initiatives, and/or cross‑functional groups. Demonstrated success improving compliant documentation capture, provider adoption, and submission integrity through EHR integrations and analytics driven suspecting
• Bachelor’s degree in nursing, public health, healthcare administration or a related field from an accredited institution required
• Master’s degree in nursing, public health, healthcare administration or a related field from an accredited institution preferred
• Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) from AAPC or AHIMA required
• CDI certification (e.g., ACDIS CCDS) or comparable documentation improvement credential preferred
• Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) or Nurse Practitioner (NP) license issued by the California BRN preferred

• Must have a valid California Driver’s license
• Comprehensive knowledge and in-depth understanding of:
  • Launching healthcare operations or behavioral change campaigns within a non-employed, independent FFS provider network
  • Prospective risk adjustment platforms, EHR alert integrations (Epic, Athena, eClinicalWorks, etc.)
  • Managing large-scale national prospective/IHA vendors (e.g., Signify, Matrix, Optum)
  • Program management, change management, and stakeholder facilitation for provider audiences. Vendor…