VP, Quality Performance and Risk Adjustment - Remote

UnitedHealth Group•New York, NY

20h•$134,600 - $230,800•Remote

About The Position

Optum NY is seeking a Vice President of Quality Performance & Risk Adjustment to join their team. Optum is a clinician-led care organization dedicated to improving how clinicians work and live. As part of the Optum Care Delivery team, you will contribute to the vision of making healthcare better for everyone. Optum provides the clinical resources, data, and support of a global organization to help patients live healthier lives. The company emphasizes an exceptional career experience, empowering employees to live their best lives at work and home, and offers the fulfillment of advancing community health while contributing new practice ideas to improve care for millions nationwide. The Vice President of Quality Performance & Risk Adjustment, Optum Health East is a senior executive role responsible for the strategic design, execution, and continuous improvement of enterprise-wide quality, risk adjustment, and value-based performance initiatives within a large, multi-state, risk-bearing healthcare organization. This role manages performance for both employed and contracted provider networks and is crucial for building and sustaining strong business partnerships with provider groups and key stakeholders. The VP acts as a liaison between clinical operations, provider organizations, health plans, and enterprise leaders, ensuring alignment across quality outcomes, accurate risk capture, regulatory compliance, and financial performance for all value-based contracts (Medicare Advantage, Commercial, Medicaid, etc.). This position is key to aligning providers, health plans, and enterprise stakeholders around shared accountability for outcomes, ensuring sustainable success in value-based, risk-bearing models through strong business partnerships, integrated quality and risk operations, and translating strategy into measurable results.

Requirements

10+ years of progressive leadership experience in healthcare quality, risk adjustment, population health, or value-based care
Experience managing performance across varied networks (i.e, multi-payer, risk and non-risk, employed and independent)
Experience with regulatory audits, compliance programs, and performance improvement planning
Demonstrated success partnering with physician groups and provider organizations in risk-bearing arrangements
Deep expertise in HEDIS, CMS Star Ratings, CAHPS, and value-based performance models
Solid understanding of CMS-HCC and/or state risk adjustment methodologies, ICD-10 coding, and documentation standards
Working knowledge of provider contracting, incentive design, and governance structures

Nice To Haves

Exceptional relationship-building and influence skills with physicians, executives, and external partners
Ability to balance enterprise priorities with provider realities to create win–win solutions
Strategic, systems thinker with strong operational execution capabilities
Clear, credible communicator able to translate complex data into meaningful action

Responsibilities

Serve as a senior relationship leader for multiple Optum East employed provider organizations, fostering collaborative, trust-based partnerships focused on shared outcomes
Act as a strategic advisor to physician leaders, medical directors, and practice executives on quality, risk adjustment, and value-based performance for both employed and contracted networks
Co-develop performance improvement plans with provider groups that balance quality outcomes, financial sustainability, and provider experience
Partner with network management and contracting teams to align quality and risk expectations within participation agreements and value-based contracts
Lead joint operating forums, governance committees, and performance reviews with provider partners
Build strong cross-functional partnerships with population health, care management, network operations, finance, actuarial, compliance, IT, and health plan stakeholders
Develop and execute a comprehensive, multi-year quality strategy aligned with organizational growth, provider network strategy, and value-based care objectives across all value-based contracts
Drive performance improvement across HEDIS, CMS Star Ratings, clinical outcomes, patient experience (CAHPS), and state-specific quality measures across multiple payers
Establish standardized yet flexible quality frameworks that can be adopted across diverse, multi-state provider groups
Partner with provider leadership to translate quality goals into practical, operational workflows
Partner with relevant national teams in quality, risk performance, IT, etc. to develop and monitor performance goals
Serve as a senior leader in reporting quality and risk performance in CDO, East regional, and national meeting forums
Serve a leader in quality incentive payment strategy across IPA network and employed CDOs
Lead enterprise risk adjustment strategy focused on accurate, compliant documentation and coding across employed and contracted providers
Partner with provider groups to embed risk capture best practices into clinical workflows
Oversee prospective and retrospective risk adjustment programs, chart reviews, and analytics
Ensure audit readiness and compliance with CMS, HHS, and state regulatory requirements
Design and lead an integrated operating model that aligns quality improvement and risk adjustment functions to reduce duplication, streamline workflows, and improve outcomes
Identify and eliminate inefficiencies across chart abstraction, gap closure, coding, and outreach activities to create a more cohesive provider experience
Standardize workflows, tools, and field resources (e.g., practice engagement, coding support, quality outreach) to present a unified approach to providers
Drive alignment of annual planning cycles, campaign calendars, and provider touchpoints across quality and risk programs
Implement shared performance metrics, dashboards, and accountability structures that reflect combined quality and risk outcomes
Partner with IT and analytics teams to integrate data platforms, reporting, and work queues to enable real-time, actionable insights
Ensure field teams and provider-facing resources are coordinated, minimizing provider abrasion and maximizing efficiency and impact
Align quality and risk adjustment strategies with population health initiatives, care management programs, and utilization management efforts
Support performance under shared savings, capitation, and global risk arrangements
Collaborate with finance and actuarial teams to model, forecast, and track the financial impact of quality and risk initiatives
Ensure providers understand how quality and risk performance directly influence total cost of care and incentive outcomes
Ensure enterprise-wide compliance with federal and state quality and risk adjustment regulations
Partner closely with compliance and legal teams to manage audits, corrective action plans, and ongoing monitoring
Serve as an executive point of contact for quality and risk-related regulatory interactions
Champion transparent, actionable reporting that enables providers and stakeholders to understand performance drivers
Establish dashboards and reporting tools tailored to executive leaders, provider groups, and frontline clinicians
Leverage predictive analytics to identify high-risk populations, care gaps, and documentation opportunities
Build, mentor, and lead high-performing teams across quality improvement, risk adjustment, coding, analytics, and provider engagement
Foster a culture of partnership, accountability, and continuous improvement
Ensure teams are equipped to support diverse provider models across multiple states