Lead Director, Risk Adjustment Informatics

Risk Adjustment & Business Performance

Leverage claims and clinical data for deep learning into drivers of performance and model impacts.

Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities.

Oversee the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.

Directs the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.

Predictive Analytics, AI & Innovation

Lead the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.

Drive innovation through automation, advanced analytics, and emerging technologies that improve efficiency and scalability.

Measure and evaluate intervention effectiveness and overall business impact.

Translate complex analytical findings into practical recommendations that improve operational, clinical, and financial outcomes.

Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities.

Strategic Leadership & Partnerships

Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning and performance improvement efforts.

Provide executive-level presentations and recommendations that influence organizational strategy and investment decisions.

Manage data relationships with external vendors and business partners.

Compliance & Regulatory Support

Ensure adherence to CMS regulations, data governance policies, and organizational compliance expectations.

Lead analytical support for compliance reviews and risk adjustment governance activities.

Establish and maintain controls that promote data integrity, auditability, transparency, and accuracy.

Monitor regulatory and industry changes, assess business impact, and ensure timely implementation of required analytic and reporting enhancements.

People Leadership

Lead, mentor, and develop a high-performing team of leaders and individual contributors across analytics, informatics, data science, and related disciplines.

Foster a culture of collaboration, innovation, continuous improvement, and results-oriented execution.

Champion technical excellence and continuous learning in areas including risk adjustment analytics, AI modeling, SQL, SAS, Python, BigQuery, and similar.