Lead, Organic Risk Adjustment

Humana

6d • $115,200 - $158,400 • Remote

About The Position

We are seeking a Lead, Organic Risk Adjustment to build, operationalize, and scale our Organic Risk Adjustment program. This is not a role focused primarily on setting strategy from the sidelines. We're looking for a builder and a doer someone who enjoys rolling up their sleeves, creating processes from the ground up, solving operational challenges, and driving results through execution. The ideal candidate is equally comfortable analyzing data, developing provider outreach plans, creating workflows, facilitating meetings, and following through on implementation. This role will work closely with clinical, operational, and analytical partners to improve documentation accuracy, risk capture, and overall program performance. Success will come from the ability to turn ideas into action and build sustainable processes that create measurable impact.

Requirements

• Bachelor’s degree or equivalent experience
• 6+ years of related lead level experience
• Experience in Medicare Advantage risk adjustment, RAF performance, clinical documentation improvement, coding, quality, or value-based care operations.
• Demonstrated ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational stakeholders.
• Experience developing provider education, documentation improvement strategies, and performance feedback processes.
• Ability to analyze data trends, identify root causes, and translate insights into operational action plans.
• Strong communication, facilitation, and stakeholder management skills.
• Ability to manage multiple priorities in a fast-paced, highly regulated healthcare environment.

Nice To Haves

• Experience leading organic or prospective risk adjustment programs.
• Experience with provider-facing documentation workflows, EMR-based interventions, suspect condition programs, or point-of-care gap closure strategies.
• Experience developing dashboards, executive reporting, or performance scorecards.
• Knowledge of Medicare Advantage operations, quality programs, Stars, care management, and value-based payment models.
• Prior people leadership or matrixed team leadership experience.

Responsibilities

• Build and operationalize programs that improve organic risk adjustment performance.
• Develop workflows, playbooks, provider engagement approaches, and reporting processes from the ground up.
• Identify opportunities, create action plans, and personally drive implementation through completion.
• Manage multiple initiatives simultaneously, ensuring deliverables are completed on time and produce measurable results.
• Serve as the point person for day-to-day execution of Organic Risk Adjustment initiatives.
• Partner directly with providers, practice leaders, operations teams, and clinical stakeholders to improve documentation and coding performance.
• Create practical solutions that fit within existing clinical workflows.
• Lead meetings, track action items, and ensure accountability across stakeholders.
• Analyze data to identify documentation and risk capture opportunities.
• Translate insights into operational actions and measurable performance improvement.
• Monitor outcomes and adjust programs based on results.

Benefits

• medical
• dental
• vision
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior