Director of Risk Adjustment & Quality Record Retrieval

About the role

The Director of Risk Adjustment & Quality Record Retrieval is responsible for leading front-line record retrieval operations that support several top strategic priorities for Humana. These high-profile priorities include Risk Adjustment's Chart Review program, Risk Adjustment internal and external audits (e.g., CMS Risk Adjustment Data Validation [RADV] audits), quality initiatives such as HEDIS, and other projects as needed.

Responsibilities

• Lead and develop a national, fully remote workforce of 300 teammates, including frontline staff, supervisors, and managers.
• Establish organizational structure, performance management frameworks, staffing models, and budget oversight to ensure a high-performing and scalable operation.
• Oversee end-to-end retrieval operations, driving performance through data-informed decision-making, goal monitoring, and operational accountability.
• Identify trends, gaps, and barriers to optimize outcomes, improve efficiency, and effectively manage escalations.
• Drive continuous improvement through the evaluation and enhancement of processes, technology, and provider engagement strategies.
• Identify opportunities to advance program performance, efficiency, and experience while remaining informed of industry trends, CMS changes, and emerging capabilities.
• Lead the implementation of operational, technology, regulatory, and organizational changes across a large, distributed workforce.
• Develop and execute change strategies that drive adoption, minimize disruption, and ensure successful delivery of enterprise initiatives through effective communication, training, and stakeholder engagement.
• Build trusted partnerships across Risk Adjustment, Stars, Interoperability, Market leadership, and other key stakeholders to align priorities, resolve issues, and ensure effective communication, escalation management, and execution of enterprise objectives.
• Foster a culture of inclusion, accountability, collaboration, and continuous learning while driving employee engagement, retention, and professional development.
• Create an environment focused on quality, outcomes, and teammate growth.
• Promote a culture of compliance and ensure adherence to privacy, regulatory, and internal policy requirements. Partner with Compliance and Legal teams to mitigate operational risk, maintain audit readiness, and support effective governance.

Qualifications

• 5+ years of leadership experience, including people leadership and large-scale initiatives.
• 3+ years of experience managing large operational processes with high-stakes outcomes.
• Demonstrated success leading teams and delivering results in dynamic, evolving business environments.
• Track record of driving measurable results through process improvement and data-driven insights.
• Best-in-class communication skills at all levels; experience articulating complex operations to senior levels (VP+) of leadership.
• Comfort making quick decisions based on quantitative and qualitative insights.
• Experience cultivating trust and collaboration across a matrixed organization.

Preferred Qualifications

• Domain knowledge of Risk Adjustment, Stars, and Medicaid.
• Experience managing large front-line teams.
• Experience managing geographically dispersed, fully remote teams.

Additional Information

• This is a remote opportunity with flexibility in work location. Louisville, Kentucky serves as a central location for the team.
• Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
• Scheduled Weekly Hours: 40
• Pay Range: $150,000 - $206,300 per year
• This job is eligible for a bonus incentive plan.
• Description Of Benefits: Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
• About Us: About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
• Equal Opportunity Employer: It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.