We are currently hiring a Director of Quality and Risk Adjustment! If you are an analytical healthcare leader, quality improvement champion, relationship builder, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!
Classification: EXEMPT | Status & Schedule: FULL-TIME, MONDAY – FRIDAY, 8AM – 5PM
Location: HYBRID/ONSITE, this position works remotely and reports to the Coos Bay Office location; travels frequently around Coos and Curry counties
Salary: $4,230.77 - $5,769.23/BI-WEEKLY
Department: QUALITY | Reports to: CHIEF COMPLIANCE & QUALITY OFFICER | Supervision Exercised: QUALITY STAFF OVERSIGHT
Job Purpose: Director of Quality and Risk Adjustment
The Director of Quality and Risk Adjustment provides strategic leadership for the development, implementation, oversight, and continuous improvement of organizational quality, risk adjustment, population health, and performance improvement programs. This position is responsible for establishing quality and risk adjustment frameworks, monitoring organizational performance, ensuring compliance with regulatory and contractual requirements. The Director collaborates with leadership, providers, and cross-functional teams to improve member outcomes, support value-based care initiatives, enhance revenue integrity, and drive organizational performance through data-informed decision making.
Qualifications, Education, & Experience
- Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, Health Information Management, or a related field required
- Master’s degree in relevant field strongly preferred
- Minimum of five years of progressively responsible leadership experience in healthcare quality improvement, performance improvement, risk adjustment, managed care, value-based payment models, or related healthcare operations
- Three to five years’ experience in Medicaid risk adjustment and coding experience
- Minimum three years’ experience in a medical office, clinic or healthcare administration setting
- Track record of success providing training, education, and guidance to providers and clinical staff
- Experience leading, training, and managing a team
- Certified Professional Coder or Certified Risk Adjustment Coder, willing to obtain within the first year of hire
Essential Responsibilities: Director of Quality and Risk Adjustment
Strategic Leadership and Program Development
- Develop and execute the organization's strategic vision for quality improvement, risk adjustment optimization, and performance improvement initiatives.
- Provide leadership in the design, implementation, evaluation, and continuous improvement of organizational quality and risk adjustment programs.
- Establish departmental goals, objectives, key performance indicators, and performance improvement strategies aligned with organizational priorities.
- Serve as a strategic advisor to executive leadership regarding quality outcomes, risk adjustment performance, population health, healthcare transformation, value-based reimbursement and regulatory requirements.
- Identify emerging trends, risks, opportunities, and best practices and develop proactive strategies to support organizational success.
- Foster a culture of continuous quality improvement, innovation, accountability, and data-driven decision-making throughout the organization.
- Collaborate with executive leadership, providers, vendors, community partners, and stakeholders to advance organizational quality and risk adjustment initiatives.
Quality Management
- Provide oversight and direction of the Quality Management Improvement (QMI) Program, Transformation and Quality Strategy (TQS), Performance Improvement Projects (PIPs), and related quality initiatives.
- Ensure the development, implementation, and monitoring of quality improvement strategies that support contractual obligations, regulatory requirements, organizational goals, and population health outcomes.
- Direct the development and utilization of evaluation tools, performance metrics, dashboards, and reporting systems used to monitor organizational performance.
- Lead efforts to improve quality performance measures, incentive metrics, healthcare outcomes, member experience, and provider performance.
- Monitor organizational performance and implement corrective action plans when performance goals are not achieved.
- Oversee the validation, analysis, interpretation, and reporting of quality and performance data.
- Ensure compliance with all applicable federal, state, accreditation, contractual, and regulatory quality requirements.
- Direct the preparation and submission of required quality reports, performance improvement reports, and contractual deliverables.
- Provide leadership to quality-related committees, workgroups, and stakeholder partnerships.
- Collaborate with clinical and operational leaders to identify opportunities for systems transformation and process improvement.
- Monitor delegated vendor performance related to quality activities and implement corrective actions when necessary.
- Oversee readiness activities associated with audits, regulatory reviews, accreditation activities, and external quality reviews.
Risk Adjustment Program Leadership
- Provide strategic oversight and direction for all organizational risk adjustment activities.
- Develop and implement comprehensive risk adjustment strategies that support organizational performance, revenue optimization, regulatory compliance, and population health goals.
- Monitor risk adjustment performance metrics, coding accuracy, documentation integrity, and program effectiveness.
- Direct provider education, engagement, and incentive strategies that support accurate clinical documentation and coding practices.
- Utilize analytics to identify trends, opportunities, and areas for improvement related to risk adjustment performance.
- Oversee relationships and performance of risk adjustment vendors, consultants, and external partners.
- Ensure implementation of auditing and monitoring activities to evaluate documentation quality, coding accuracy, and program compliance.
- Collaborate with internal departments and external stakeholders to resolve issues affecting risk adjustment performance and compliance.
- Develop, implement, and maintain policies, procedures, and workflows supporting risk adjustment activities.
- Monitor changes in risk adjustment methodologies, payment models, and regulatory requirements and implement program modifications as needed.
Performance Management and Analytics
- Provide strategic oversight of quality performance, risk adjustment analytics, population health metrics, and organizational performance measurement activities.
- Develop, monitor, and report key performance indicators, dashboards, scorecards, and other performance measurement tools to support organizational goals and data-driven decision-making.
- Analyze quality, risk adjustment, utilization, financial, and population health data to identify trends, care gaps, coding opportunities, performance variances, and opportunities for improvement.
- Direct the collection, interpretation, and communication of performance data and outcomes to executive leadership, providers, committees, and key stakeholders.
- Collaborate with clinical, operational, and provider teams to develop and implement performance improvement strategies that enhance member outcomes, patient experience, provider performance, and operational effectiveness.
- Monitor performance against contractual, regulatory, payer, and organizational benchmarks and develop corrective action plans when performance targets are not achieved.
- Ensure the integrity, accuracy, and effective use of quality, risk adjustment, utilization, and population health data to support quality improvement, strategic planning, and organizational performance initiatives.
For a full job description and to formally apply, please visit www.advancedhealth.com/careers
Pay: $110,000.00 - $150,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Ability to Commute:
- Coos Bay, OR 97420 (Required)
Work Location: Hybrid remote in Coos Bay, OR 97420
