Director, Quality Analytics - Risk Adjustment (director Ii)

CalOptima Foundation

Orange, CA, US
Base: $181,257 - $290,011; bonus/equity: not speci...
On-site
7 years risk adjustment program leadership
5 years medicare advantage experience
Direct supervision of staff required
The role involves leading a cross-functional team to manage risk adjustment programs for Medicare, Medi-Cal, and Covered California

Job Summary

  • The role involves leading a cross-functional team to manage risk adjustment programs for Medicare, Medi-Cal, and Covered California.
  • Candidates must ensure adherence to official regulatory guidelines including CMS mandates while driving continuous quality improvements.
  • The position offers competitive compensation ranging from $181,257 to $290,011 along with comprehensive benefits including CalPERS pension.

Matching Summary

The role involves leading a cross-functional team to manage risk adjustment programs for Medicare, Medi-Cal, and Covered California.

Salary

Base: $181,257 - $290,011; Bonus/Equity: Not specified; Benefits: CalPERS pension, PTO, tuition reimbursement

Skills & Requirements

Must-have

  • 7 years Risk Adjustment program leadership
  • 5 years Medicare Advantage experience
  • Direct supervision of staff required
  • Hierarchical Condition Categories HCC expertise
  • Chronic Illness Disability Payment System CDPS
  • CMS regulatory compliance knowledge

Nice-to-have

  • Master's degree in health management
  • Certified Risk Adjustment Coder certification
  • Vendor oversight and KPI monitoring
  • Cross-functional team collaboration
  • Strategic planning for value-based care

Key Requirements

  • Bachelor's degree in business or health administration
  • 7 years overseeing Risk Adjustment programs
  • 5 years working with Medicare Advantage Plans
  • 5 years progressive leadership experience
  • Direct supervision of staff required

Work Rights

Must be authorized to work in the State of California

Tailored Resume

Cover Letter