Director, Product Manager, Risk Adjustment

Matrix Medical Network•UNAVAILABLE, UNAVAILABLE

4d•Remote

About The Position

Every risk adjustment platform says they create a complete, accurate and compliant view of member health. We believe that's thinking too small. At Matrix, we're building technology that helps clinicians tell a more complete patient story, one that improves care, strengthens documentation, ensures regulatory compliance and creates measurable value for health plans and providers alike. If you're the kind of Product Leader who sees risk adjustment as a strategic advantage, not just a compliance exercise, we'd love to meet you. This isn't a role where you'll optimize one feature or own one backlog. You'll define how data, clinical workflows, AI, interoperability and mobile technology come together to reshape how millions of members are assessed across Medicare Advantage, ACA Marketplace and Medicaid. You'll own one of the most strategically important products in our portfolio. You'll lead product strategy for the technology that powers our Risk Adjustment ecosystem, including careflow™, Matrix's mobile platform used by Nurse Practitioners during in-home health assessments. Your mission centers around three product pillars: Enrich Create the industry's most complete member health picture. Bring together claims, clinical records, pharmacy, labs, supplemental data, HIEs and APIs into a unified view that equips clinicians before they ever knock on a patient's door. Capture Help clinicians document the right conditions the right way. Design intelligent assessments, clinical decision support, documentation prompts, conditional logic and AI-enabled workflows that improve clinically supported documentation while reducing provider burden. Measure Shape the future of clinically grounded, compliant, and member-centered risk adjustment. Define the KPIs that matter, from documentation quality, clinical completeness, audit readiness, operational performance and recapture rates to documentation quality, first-pass yield, Actual vs. Expected disease burden and audit readiness, and make them visible to executives and clients alike. You'll Be Responsible For Defining and executing the product roadmap across prospective and retrospective risk adjustment workflows Building scalable capabilities supporting Medicare Advantage (CMS-HCC), ACA Marketplace (HHS-HCC), and Medicaid risk adjustment models Driving enhancements inside careflow™ that improve clinician experience and documentation quality Partnering with Clinical, Coding Operations, Engineering, Compliance, Finance, Customer Success and Executive Leadership Translating evolving CMS regulations, including V28, RADV and Medicaid model changes, into product strategy before the market catches up Leading build vs. buy decisions around AI-assisted coding, NLP, longitudinal patient records, audit analytics and risk prediction platforms Expanding interoperability through APIs, HIEs and FHIR-enabled data exchange Defining the analytics and reporting that demonstrate measurable client value Representing Product with customers and helping shape the future roadmap through real-world feedback

Requirements

5+ years of Product Management experience
2+ years working within healthcare payer, value-based care or Risk Adjustment
Deep understanding of HCC coding and CMS Risk Adjustment models across Medicare Advantage, ACA and Medicaid
Experience translating CMS regulatory changes into product strategy
Strong analytical skills with experience interpreting RAF performance, coding gaps, recapture metrics, encounter data and operational KPIs
Familiarity with APIs, HIEs, FHIR and healthcare interoperability
Demonstrated success leading highly cross-functional teams without direct authority
Confidence representing product strategy with customers and executive stakeholders

Nice To Haves

AI or NLP-assisted coding platforms (Optum, Apixio, Episource, Veradigm, etc.)
Clinical Documentation Improvement (CDI)
Provider query workflows
HEDIS or Star
Value-Based Care organizations
Longitudinal patient data platforms
In-home clinical services

Responsibilities

Defining and executing the product roadmap across prospective and retrospective risk adjustment workflows
Building scalable capabilities supporting Medicare Advantage (CMS-HCC), ACA Marketplace (HHS-HCC), and Medicaid risk adjustment models
Driving enhancements inside careflow™ that improve clinician experience and documentation quality
Partnering with Clinical, Coding Operations, Engineering, Compliance, Finance, Customer Success and Executive Leadership
Translating evolving CMS regulations, including V28, RADV and Medicaid model changes, into product strategy before the market catches up
Leading build vs. buy decisions around AI-assisted coding, NLP, longitudinal patient records, audit analytics and risk prediction platforms
Expanding interoperability through APIs, HIEs and FHIR-enabled data exchange
Defining the analytics and reporting that demonstrate measurable client value
Representing Product with customers and helping shape the future roadmap through real-world feedback