Dir. Medicare and Risk Adjustment Strategic Initiatives

Cambia Health Solutions•Renton, WA

13d•Hybrid

About The Position

Dir. Medicare and Risk Adjustment Strategic Initiatives Work a Hybrid schedule within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of Dir. Medicare and Risk Adjustment Strategic Initiatives is living our mission to make health care easier and lives better. As a member of the Government Programs team, our The Director Medicare and Risk Adjustment Strategic Initiatives partners with the leadership team to optimize strategic governance, planning and execution in support of day-to-day priorities within the strategic plan. Leads strategic projects, provides relevant data insights and reporting, prepares executive communications, facilitates leadership meetings and agendas, and oversees annual planning processes. And provides counsel to senior management and directs cross-functional teams to influence change. In Medicare Risk Adjustment the role provides strategic leadership to develop internal talent and address critical operational gaps. Works alongside the Risk Adjustment leader to transform approach into a proactive, well-organized operation that maximizes team potential while delivering measurable business results – all in service of creating a person-focused health care experience . Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: The Director Medicare and Risk Adjustment Strategic Initiatives would have a BA/BS in business management, healthcare administration, finance or relevant field, MBA or MHA preferred, and at least 10 years of executive business strategy, planning, and performance management experience. Or equivalent combination of education and experience. Manages up to 10 FTEs (temporary and permanent) in addition to managing projects with consulting firms. Skills and Attributes: Provides leadership to Acceleration Office functions by directing the performance management model for business strategies and coaching delivery leaders to achieve execution success, in partnership with the Acceleration Office Lead. Navigates the matrix, influencing without direct authority, and fosters a collaborative work environment to drive impact. Manages division rhythm of the business (ROB), business operating reviews, and executive reporting. Directs performance improvement in managing vendors as appropriate. Manages cross-cutting initiatives and enablers to deliver value (e.g. in-home assessments). Manages special projects and participates in enterprise committees and workgroups as needed. Advises and supports the SVP Government Programs with running the division, leadership engagement, and external engagement. Represents the division on behalf of the SVP Government Programs as assigned and provides input to corporate objectives and business decisions based on impact to Medicare programs. Proactively address business issues and collaborate with team members to solve problems quickly and thoughtfully. Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise. Demonstrates and fosters an ability to work effectively with existing leadership and generate positive team responses. Demonstrates a strong understanding of operational analytics to work with analytics teams. Provides a calm, strategic mindset during challenging situations. Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise

Requirements

BA/BS in business management, healthcare administration, finance or relevant field
at least 10 years of executive business strategy, planning, and performance management experience
Provides leadership to Acceleration Office functions by directing the performance management model for business strategies and coaching delivery leaders to achieve execution success, in partnership with the Acceleration Office Lead.
Navigates the matrix, influencing without direct authority, and fosters a collaborative work environment to drive impact.
Manages division rhythm of the business (ROB), business operating reviews, and executive reporting.
Directs performance improvement in managing vendors as appropriate.
Manages cross-cutting initiatives and enablers to deliver value (e.g. in-home assessments).
Manages special projects and participates in enterprise committees and workgroups as needed.
Advises and supports the SVP Government Programs with running the division, leadership engagement, and external engagement.
Represents the division on behalf of the SVP Government Programs as assigned and provides input to corporate objectives and business decisions based on impact to Medicare programs.
Proactively address business issues and collaborate with team members to solve problems quickly and thoughtfully.
Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise.
Demonstrates and fosters an ability to work effectively with existing leadership and generate positive team responses.
Demonstrates a strong understanding of operational analytics to work with analytics teams.
Provides a calm, strategic mindset during challenging situations.
Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise

Nice To Haves

MBA or MHA preferred

Responsibilities

Leads development of multi-year strategies, roadmaps, KPIs for targeted business functions (Risk adjustment is focus for 2026).
Facilitates and supports annual business planning activities for the division in partnership with Actuary and Strategic Finance leaders.
Defines targets and priorities to improve county MLRs, member MLRs, and provider performance for Medicare Advantage.
Provides decision support expertise to senior leadership team on strategic and operational matters.
Develop talent, strengthen capability, and develop future Risk Adjustment leadership.
Lead/support development and execution of long-term organizational goals.
Focus on overall success and long-term organizational goals rather than just tactical execution.
Thought leadership to boost performance and effectiveness of underperforming RA campaigns.
Ability to establish end-to-end accountability for critical processes like MRA, EMR records management, QIP, CDI, and IHA programs, as some programs currently lack dedicated ownership.
Experience building sustainable infrastructure and improving operational efficiency for the RA team that lacks proper organization.
Strategic oversight of vendor relationships and chart retrieval operations with significant improvement opportunities.
Capability to strengthen QIP, CDI, IHA, and provider education programs.

Benefits

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.

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