Sr Director Advisory Services Risk Adjustment – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

The Sr Director of Risk Adjustment is a leader within the Optum Advisory Services accountable for: Leading the risk adjustment consulting team. Involved in the daily management of multiple levels of staff and multiple functions/departments across the solution teams and client teams engaged in risk adjustment deals. Responsible for facilitating the effectiveness and impact of the consulting team. Acts as an advisor and sounding board to help establish business direction and drive business performance in the risk adjustment operations areas. Develops executive presentations/materials, coordinates requests, and supports the client’s planning process in the function impacted by our solutions. This role is accountable for delivering agreed upon results for both the client and Optum.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

 

Primary Responsibilities:

Risk Adjustment Program Strategy & Execution Consulting

• Asses Clients to develop and execute risk adjustment strategy focused on compliant and accurate capture of member health status to optimize RAF performance
• Identify, prioritize, and implement RAF improvement and clinical documentation initiatives including prospective reviews, retrospective coding, provider education opportunities, suspecting models, and member stratification
• Partner with Clinical and Care Management teams to align risk adjustment strategy with population health, care coordination, and quality improvement initiatives
• Vendor Oversight, SLA Management & KPI Monitoring Consulting
• Provide consulting guidelines for client governance and oversight of risk adjustment vendors including coding, chart retrieval, submissions, provider outreach, and analytics partners
• Provide consulting for clients to develop and enforce vendor SLAs and performance guarantees to ensure accountability for quality, accuracy, turnaround time, and regulatory adherence
• Provide best in class guidance for establishing and maintaining KPI reporting dashboards and operational scorecards to monitor vendor and internal performance
• Partner with Procurement and Legal teams to ensure vendor contracts support operational needs and compliance requirements when needed

Regulatory Oversight & Compliance Consulting

• Ensure up to date understanding of compliance with all CMS, HHS, and state risk adjustment regulations and guidelines related to coding, submissions, chart review and audit readiness
• Lead internal audit processes, submissions validation, and issue resolution to mitigate compliance risk for services purchased by clients
• Serve as subject matter expert on regulatory changes and translate into operational requirements

Coding Program Oversight & Data Submissions Management Consulting

• Oversee coding policies, audit routines, education, and governance processes to ensure coding accuracy and integrity
• Partner with IT, Data, Submission Vendors and Analytics teams to strengthen submission operations, data flow, data dashboard and or error remediation processes that are supported by Optum Products

Cross-Functional Leadership

• Build solid partnerships with internal teams including Quality, Stars, Population Health, Technology, Provider Engagement, Actuarial, Finance and Optum Products for each line of business
• Collaborate to ensure risk adjustment strategy supports enterprise growth, member engagement and revenue integrity goals

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:        

• 7+ years of progressive leadership experience in risk adjustment strategy, risk adjustment operations, and risk adjustment consulting within health plans or vendor organizations
• Deep knowledge of CMS risk adjustment regulations, HHS ACA requirements, Medicaid risk adjustment methodologies, and coding standards
• Experience developing operational KPIs, dashboards, and reporting tools to drive program visibility and performance
• Demonstrated success leading RAF improvement strategies, coding programs, data submissions, and audit readiness
• Solid understanding of risk adjustment data flows, suspecting models, and member stratification techniques
• Willingness and ability to travel up to 50% per client needs

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

The salary range for this role is $150,200 to $288,500 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.