Director, Risk Adjustment Product & Technology
About The Position
The Director, Risk Adjustment Product & Technology will lead the product roadmap, and technology capabilities that enable Mosaic Health to identify, prioritize, orchestrate, and capture burden-of-illness opportunities across its patient populations. This role will own the evolution of Mosaic’s enterprise Burden of Illness (BOI) Hub—the centralized intelligence and orchestration layer that brings together clinical, claims, payer, attribution, and supplemental data to determine which patients and clinical opportunities should be acted upon, through which intervention, and at what point in the workflow. The Director will move the organization from fragmented, vendor-specific, and manually driven prioritization toward an enterprise-owned approach to risk adjustment decisioning and orchestration. The role will oversee how opportunities are identified, deduplicated, economically prioritized, routed to the appropriate execution engine, and measured through completion. Sitting within Clinical Technology, this leader will partner closely with Risk Adjustment, Clinical, Coding, Operations, Product, Engineering, Data & Analytics, Finance, and market leadership. The Director will also serve as a senior product and technology partner to external vendors, ensuring that platforms such as Navina operate as execution engines within Mosaic’s broader enterprise strategy rather than independently defining prioritization and workflow. The successful candidate will combine expertise in risk adjustment, healthcare product management, clinical technology, data, workflow design, and value-based care economics.
Requirements
- Expertise in risk adjustment
- Healthcare product management experience
- Clinical technology experience
- Data expertise
- Workflow design experience
- Value-based care economics experience
Responsibilities
- Own the product vision, strategy, roadmap, and operating model for Mosaic’s enterprise risk adjustment technology capabilities.
- Lead development and maturation of the Burden of Illness Hub as the central orchestration capability for risk adjustment and related clinical opportunities.
- Translate Risk Adjustment, Clinical, Operations, market, payer, and financial requirements into scalable product and technology capabilities.
- Establish a clear distinction between: enterprise-owned decisioning and prioritization, foundational data capabilities, execution engines, vendor functionality, and provider, coder, and operational workflows.
- Define the target-state architecture and multi-year roadmap for moving from fragmented tools and processes to a standardized enterprise platform.
- Build the Hub as the enterprise system for: patient eligibility and prioritization, attributed and high-probability unattributed population identification, suspect and opportunity aggregation, opportunity deduplication, clinical and economic prioritization, work queue generation, intervention routing, opportunity status and disposition, attribution and retention interventions, and enterprise performance analytics.
- Establish common rules and governance for determining when an opportunity should be surfaced, suppressed, combined, escalated, or routed to an alternative intervention.
- Ensure prioritization logic is transparent, measurable, and configurable by population, payer, market, and intervention type.
- Create feedback loops in which outcomes from providers, coders, AI, and other interventions continuously improve future prioritization.
- Own product requirements and prioritization for risk adjustment technology capabilities across the enterprise.
- Partner with Engineering, Data, Architecture, and Clinical Informatics to translate business requirements into scalable technical solutions.
- Define product requirements, user stories, workflows, acceptance criteria, and outcome measures for major capabilities.
- Maintain a prioritized product backlog and roadmap aligned to enterprise objectives.
- Establish appropriate product governance, release planning, testing, adoption, and change-management processes.
- Ensure risk adjustment technology integrates effectively with EHRs, clinical applications, analytics platforms, data infrastructure, and operational systems.
- Evaluate emerging technologies—including AI, NLP, clinical inference, and automation—for their ability to improve identification, prioritization, and capture of clinically appropriate opportunities.
- Ensure that multiple execution channels operate against a common enterprise prioritization strategy, including: Point-of-care clinical technology and provider workflows, Platforms such as Navina, Coding and chart review teams, Incremental AI and clinical rules, Prospective and retrospective interventions, Provider and coder workflows, Attribution and patient retention interventions, Operational outreach and work queues.
- Define when and how opportunities move between these execution channels and establish clear ownership, handoffs, and disposition logic.
- Collaborate with clinical, operational, analytics, finance, compliance, and technology teams to align priorities and execution.
- Lead and mentor multidisciplinary teams including workflow analysts, clinical informatics resources, optimization specialists, and program managers.
- Manage vendor relationships and participate in technology selection and evaluation processes.
- Support enterprise scaling efforts, acquisitions, integrations, and operational transformation initiatives.
- Define and monitor operational and clinical metrics tied to workflow optimization initiatives.
- Use data and analytics to identify inefficiencies, quantify impact, and guide prioritization decisions.
- Develop executive-level reporting demonstrating ROI, adoption, productivity, and quality outcomes.
- Drive continuous improvement methodologies across workflow and technology initiatives.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
