Director Healthcare Economics, Risk Adjustment

UnitedHealth Group•Eugene, OR

2d•$65 - $111•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Optum Health National Risk Adjustment Healthcare Economics Team leads enterprise-wide risk adjustment analytics and strategy, with a primary focus on Medicare Advantage risk modeling and revenue forecasting. Our work spans in year performance measurement, development of leading indicators tied to risk adjustment outcomes, standardization of forecasting processes, and synthesis of insights for internal stakeholders and executive leadership. We serve as trusted analytical partners to finance, operations, accounting, and clinical leaders—helping identify opportunities, forecast risk scores and revenue, and interpret complex risk adjustment dynamics. If you are enthusiastic about risk adjustment and thrive in a data-driven environment, this is the place to make an impact. As a Director and thought leader in Risk Adjustment, you will guide key strategic initiatives related to Medicare Advantage data, reporting, and analytic innovation. You will collaborate with senior leadership, technical teams, and subject matter experts to shape processes, elevate analytic rigor, and ensure insights are accurate, actionable, and aligned to enterprise priorities. Success in this role requires deep expertise with CMS Medicare Advantage payment models, as well as advanced proficiency accessing, structuring, and analyzing large datasets using SQL, SAS, or similar analytical tools. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

7+ years of healthcare analytics experience focused on risk adjustment, including 3+ years in a leadership or strategic role
Experience with CMS Medicare Advantage data files (MMR, MOR, MAO 004) supporting forecasting, reconciliation, or program performance analysis
Proficiency in SQL, Snowflake, Python, or similar tools for large-scale data management
Expert-level understanding of CMS Risk Adjustment models and their application to revenue forecasting and analytics
Advanced analytic skills including data analysis, manipulation, extraction, and reporting
Demonstrated ability to lead complex analytics initiatives and collaborate across cross functional teams

Nice To Haves

Experience with advanced forecasting methodologies in a healthcare environment
Broader familiarity with CMS regulations and specifications beyond Medicare Advantage risk adjustment
Skilled in project management and documentation practices
Experience supporting finance or revenue-focused teams
Experience in predictive modeling, advanced data manipulation, and complex reporting
Ability to synthesize analysis into actionable, visually compelling insights
Experience measuring ROI and evaluating the impact of operational programs
Excellent communication skills with experience presenting technical concepts to executive audiences

Responsibilities

Advise a highly skilled technical team that analyzes data to drive risk adjustment analytics primarily for the Medicare Advantage population
Partner with business stakeholders to understand analytical needs, shape strategy, and oversee execution of analytics, reporting, and solution development
Provide clear, data driven insights to national and regional leaders on performance trends, opportunities, and improvement priorities
Guide the development and adoption of best in class processes, tools, and capabilities to support data reconciliation, minimize data leakage, and risk adjustment insights
Oversee creation of concise, executive ready summaries of analytical findings across multiple channels (presentations, dashboards, email updates, and verbal briefings)
Educate stakeholders of various knowledge levels on the topic of Risk Adjustment from various vantage points—the clinical, operational, and financial
Direct the operationalization of scalable reporting and flexible analytic infrastructure to support evolving KPIs and business growth
Leverage enterprise-wide capabilities to support business objectives and deliver integrated solutions
Provide mentorship, technical guidance, and development support to junior analysts and team members