Vice President Risk Adjustment Remote
Vice President Risk Adjustment Remote
Posted on :
12-04-2025
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
12-04-2025
Job Description
The Vice President of Risk Stratification plays a critical role in shaping and implementing a strategic approach to risk stratification. This senior leadership position focuses on utilizing data analytics to identify highrisk populations allowing for targeted interventions and improved care management to mitigate potential adverse events. This role will lead teams in analyzing patient data building risk models and collaborating with stakeholders to optimize patient outcomes based on their risk level.
Reporting directly to the Senior Vice President of Affordability and Risk Initiatives this role will collaborate closely with leadership of Affordability and Quality initiatives to integrate best practice workflows for managing the health of the risk pool. In addition this senior leader will demonstrate strength in provider engagement payment and risk sharing models collaborative care models data/analytics support member engagement health improvement and management programs as well as collaboration with vendor partners to achieve identified goals.
This autonomous and outcomeoriented role requires strong leadership in influencing internal and external stakeholders fostering alignment and driving meaningful change in the way healthcare is delivered. Additionally the Vice President of Risk Stratification contributes to Aledades Strategy and Priority Leadership Team tasked with informing the companys overall strategic direction.
Primary Duties:
- Leads a team of subject matter experts data analysts clinical documentation integrity specialists and coders quality auditors and other relevant personnel providing guidance and expertise on risk assessment methodologies.
- Lead compliance initiatives and serve as the primary liaison for all Compliance and Legal projects ensuring alignment with regulatory standards and organizational goals. Leverage extensive experience in developing and executing compliancedriven programs to mitigate risk and drive organizational success.
- Partner closely with techproductanalytic teams to design and maintain sophisticated risk algorithms using patient demographics clinical data and other relevant factors to accurately identify highrisk patients across different patient populations.
- Collaborate with the Analytics team to consume all available data sources from health plans analyze large datasets and extract meaningful insights and identify trends related to patient risk profiles.
- Develop a roadmap that defines the path to operationalize specific actions which are repeatable measurable and costeffective.
- Track key performance indicators (KPIs) across all contracts related to risk stratification including # visits RAF score complete and accurate diagnosis coding to the highest degree of specificity thorough and accurate documentation and where appropriate diagnoses recapture rates diagnoses resubmissions etc.
- Partner with clinical teams care management and leadership to effectively communicate risk assessments and implement targeted interventions based on risk stratification results.
- Ensure adherence to relevant healthcare regulations and guidelines related to risk stratification and data privacy. Oversee auditors and auditing practices such as implementing an internal QA process for diagnosis coding and documentation as well as liaising between health plan risk adjustment auditors and Aledade practices.
Minimum Qualifications:
- Required: Bachelors Degree with 15 years experience in healthcare. Ideal candidates will have a combination of seniorlevel experience and expertise in health care strategy health plans business development management consulting health care finance and provider operations.
- Preferred: Masters degree or other advanced degree(s) in business health administration and/or public policy or other relevant fields.
- 5 years of successfully leading and executing a comprehensive Risk Stratification program at scale
- Required: Deep knowledge of Risk Stratification in Medicare Advantage and Commercial (ACA HMO PPO) plans are required. Preferred: Knowledge of MSSP and Medicaid.
- Proven track record of working collaboratively with clinical and operational colleagues across the organization as well as deep experience leading teams managing projects and driving strategic initiatives
- Deep understanding of healthcare terminology clinical conditions and disease progression
- Ability to manage multiple deadlines
- Ability to communicate complex data insights effectively and sensitively to diverse stakeholders including clinicians executives regulatory bodies and care teams in stressful situations
- Ability to lead by influence to engage colleagues and lead teams crossfunctionally
- Proficiency in data analysis techniques statistical modeling and predictive analytics
- Familiarity with data warehousing data mining tools and healthcare information systems
- Experience in fostering networks internally and externally
Preferred Qualifications:
- Exceptional communication and organization skills
- Project management experience
- Systemsthinker (data management software administration)
- Experience developing educational tools/documentation
- Passionate about healthcare and interested in making a positive impact in the field
- A committed selfstarter who is able to take initiative and ownership of projects
- A collaborative team player
- Detail oriented and selfmotivated to produce work that meets high standards
- Google Suite particularly Google Sheets and Google Slides
- Tableau
- General Skills at data visualization
Physical Requirements:
- Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
Who We Are:
Aledade a public benefit corporation exists to empower the most transformational part of our health care landscape independent primary care. We were founded in 2014 and since then weve become the largest network of independent primary care in the country helping practices health centers and clinics deliver better care to their patients and thrive in valuebased care. Additionally by creating valuebased contracts across a wide variety of health plans we aim to flip the script on the traditional feeforservice model. Our work strengthens continuity of care aligns incentives and ensures primary care physicians are paid for what they do best keeping patients healthy. If you want to help create a health care system that is good for patients good for practices and good for society and if youre eager to join a collaborative inclusive and remotefirst culture youve come to the right place.
What Does This Mean for You
At Aledade you will be part of a creative culture that is driven by a passion for tackling complex issues with respect openmindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences interests backgrounds beliefs and achievements to their work and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support worklife balance and enjoyment we offer the following comprehensive benefits package designed for the overall wellbeing of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health dental and vision insurance paid up to 80 for employees dependents and domestic partners
Robust timeoff plan 21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4 match
Stock options
And much more!
At Aledade we dont just accept differences we celebrate them! We strive to attract develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit qualifications performance and business needs. All qualified candidates will receive consideration for employment without regard to age race color national origin gender (including pregnancy childbirth or medical conditions related to pregnancy or childbirth) gender identity or expression religion physical or mental disability medical condition legally protected genetic information marital status veteran status or sexual orientation.
Privacy Policy:By applying for this job you agree to AledadesApplicant Privacy Policy available at Experience:
Chief
Employment Type
Full-Time
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