Sr. Manager - Risk Adjustment - Inland Empire/San Diego

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Provide strategic leadership and oversight of multi-market risk adjustment and population health operations, managing Manager-level leaders and multi-layered teams while driving talent development, performance management, accountability, and operational consistency.
• Lead enterprise-wide and cross-regional risk adjustment initiatives from strategy through execution, including retrospective chart reviews, provider outreach, coding optimization, annual wellness visits, and documentation improvement programs.
• Establish and standardize operational workflows, governance structures, policies, and best practices to improve scalability, efficiency, coding accuracy, and performance across markets and provider networks.
• Oversee program performance, resource allocation, capacity planning, vendor relationships, and budget recommendations while driving outcomes related to RAF performance, documentation integrity, coding accuracy, and productivity.
• Analyze operational and financial performance metrics to identify trends, gaps, and improvement opportunities; develop strategic action plans and provide recommendations to executive leadership.
• Partner with clinical, operational, provider, health plan, and executive stakeholders to align enterprise initiatives, strengthen provider engagement, resolve complex operational issues, and advance organizational objectives.
• Ensure regulatory and compliance standards are met across all programs, including CMS, NCQA, and DMHC requirements, overseeing audits, chart reviews, quality assurance, and corrective action plans.
• Other duties as assigned.

Qualifications

• 7–10 years of healthcare operations, risk adjustment, population health, or managed care experience, including 4–5 years of progressive leadership experience overseeing managers or multi-layered teams.
• Demonstrated experience leading large-scale, cross-functional risk adjustment programs and enterprise-wide initiatives across multiple markets or business units.
• Proven ability to develop organizational strategy, drive performance improvement, and lead complex operational initiatives.
• Advanced expertise in risk adjustment, HCC coding, value-based care programs, and applicable regulatory requirements, including CMS and NCQA.
• Strong subject matter expertise in risk adjustment strategy, program design, provider performance optimization, and operational excellence.
• Exceptional leadership, project management, and change management skills, with experience managing multi-level teams and enterprise-scale initiatives.
• Strong analytical, communication, presentation, and relationship management skills, with the ability to influence executive stakeholders and drive data-informed decisions.
• Preferred certifications: CRC, CPC, CCS, RHIA, RHIT, or equivalent.

Environmental Job Requirements and Working Conditions

• This is a full-time, hybrid position, where you will be expected to work from home and also travel to provider office throughout Inland Empire and San Diego.
• The national target compensation for this position is $120,000 - $140,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.