Senior Director, Risk Adjustment Operations

Evolent Health - Phoenix, AZ3.7

This position will be located in our Phoenix, AZ office. Applicants must be within a commutable distance and/or willing to relocate for the role. Relocation expenses will be reimbursed.

What You’ll Be Doing:
Evolent Health is looking for a Senior Director of Risk Adjustment Operations. This position is responsible for driving initiatives related Risk Adjustment management to ensure that health plan performance is on track with targets. Working with both our client and partner organizations, the Senior Director will have a critical role in in driving performance improvement, devising the approach for implementation, and managing deployment of performance related initiatives for our Phoenix-based client partner.


The position is responsible for managing the operations process for multi-year, large scale Risk Adjustment (RA) initiatives. Projects may be related to business process/technology migrations, process-design, program deployment and new initiatives related to the client RA program. Responsible for the overall execution of the RA program across all key focus areas while specifically ensuring key metrics and timelines are met.

Build and maintain client relationships with client leadership, building credibility and garnering crucial support programs
Serve as the Risk Adjustment program lead in client and health plan conversations, displaying a strong grasp on the intricacies of the models
Consult with and educate clients, translating technical information into actionable solutions
Ensures early detection of major risks and interdependencies
Oversee program management for client engagement to ensure project plans and resource budgets are up to date and that projects are on track to meet or exceed budgeted costs and timelines
Manage resources, timeline, and budget to effectively deliver on projects to exceed client expectations and commitments and maintain the IOI on the project
Report on project status, risks, issues, and resource needs on a weekly basis internally
Identify resources for projects using internal resources as well as subcontractors
Develop systems for monitoring and tracking progress and processes for escalating potential issues
Client Management and Client Satisfaction (40% Time Allocation):

Work with client to lay out strategic roadmap for Risk Adjustment solution
Provide financial and data analysis to support ROI for project funding
Obtains high client satisfaction scores (>90%)
Develop and maintain client references

Program Oversight & Service Delivery (60% Time Allocation):
Direct responsibility for the oversight, hands on participation and delivery of large scale projects/programs. Large scale programs are defined as high cost, high complexity and/or high risk
Ensure utilization rate and billable revenues are attained annually
Facilitate development of business segment and enterprise level planning and program objective setting
Provide strategic input to the development of program roadmap and timelines
Create a team oriented work climate that enables professional development and encourages creative solutions and strategies
Support the management of resources within programs
Ensure communication between the various stakeholders, business leaders and cross functional teams
Establish and maintain effective, collaborative working relationships with Evolent internal/central Operations, our key business partners, and contracted vendors
Require that quality assurance methods are implemented within the program
Provide status updates and review of programs to senior leadership
Provide coaching and mentoring of project team with the goal of developing and retaining talent within the organization

The Experience You Need (Required):
Bachelor's Degree and/or Master Preferred
Professional experience in a leadership in a large, complex and integrated health care delivery system.
7-10+ years of experience in managing large enterprise-level programs
5-7+ years of experience in Managed Care, Payer/Provider/Health Plan and/or Health system management
3+ years of experience in Medicare advantage and/or Medicaid and/or ACA
3+ years risk adjustment experience with expertise in one or more lines of business and/or risk adjustment functional areas; Chart Review and/or In-Home assessment and/or Provider education and/or Prospective programs and/or member engagement and/or Submissions
Ability to help design effective solutions to work collaboratively with client management
Ability to travel locally (Phoenix area) up to 20% of the time.
This position will be located in our Phoenix, AZ office. Applicants must be within a commutable distance and/or willing to relocate for the role. Relocation expenses will be reimbursed.

Finishing Touches (Preferred):
Understanding of Risk Adjustment Factor methodology and approaches to support accurate coding
Experience and fluent in revenue cycle management systems and other healthcare financial performance.
Experience with payers and billing including knowledge of ICD-10 coding guidelines
Superior leadership experience, particularly in cultivating a high performing team, and in developing and maintaining excellent relations with physicians and staff at all levels.
Strong client management experience, having demonstrated an ability to communicate effectively and partner with client executives
Demonstrated track record for achieving performance results
Excellent written and oral presentation skills, with the ability to engage, inspire, build credibility and engender trust across all levels of an organization
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.