Job Openings

Director, Risk Adjustment & Quality

Twitter Facebook
Portland, OR
Job Type
Direct Hire
Jan 15, 2020
Job ID

Director, Risk Adjustment & Quality  – Portland, OR



Reporting to the CFO in Oregon,  Director oversees regional business in the Northwest.

Working closely with Corporate Risk Adjustment Team, will partner with business areas that include: Provider Contracting, Vendor Procurement .


Main focus is to oversee the business processes related to risk adjustment and quality improvement for assigned products and plans. 

-Development and implementation of action plans, across all departments and any vendor partners affecting assigned products and plans, to address issues identified by the business units, including detailed work plans, issue logs, and progress reports

- Identify and partner with various departments to implement assigned products business requirements

-Develop end to end roadmap from regulatory compliance to strategic advantage

-Develop and execute operational workflows specific to each product business requirements, competitive landscapes, and local market dynamics

-Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products

-Identify and support company- wide risk adjustment and quality initiatives related to assigned products

-Prepare dashboards for senior management and identify improvement opportunities

-Review and ensure compliance with all federal and state regulations, guidance, and technical specifications



- Bachelor’s degree in related field.

-7+ years of risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry.

- Project Management Leadership experience strongly preferred

- Previous experience in value-based revenue and quality improvement initiatives with various health insurance product(s) preferred.

- Previous managed care - Medicare preferred.