Primary Duties:
- Collaborate within and across departments for platform improvements for operational execution by the Field. Develop strategies and tactics to improve risk adjustment market capture through technology and product enhancements. Drive continuous improvement across departments (product, tech, analytics, Aledade plus and other departments) through influence and inspiration.
- Lead strategic projects in Risk workstreams, as requested by SVP of Affordability and Risk. These may include but are not limited to the areas of Clinical Documentation Integrity (CDI), revenue integrity, vendor management, and decisions based on data in support of Performance projects. In the Risk Key Result (led by SVP of Affordability and Risk), expect to lead at least one sub-KR such as improving performance in customer interactions with suspected chronic conditions (visits, views, resolving, redocumentation).
- Partners closely with the Clinical Engagement Team (CET), including Regional Medical Directors, to assess and operationalize feedback related to platform enhancements. Where applicable, leverages clinical expertise to lead or support strategic initiatives aligned with the individual’s clinical training (e.g., nurse, advanced practitioner, physician). Clinical credentials are not required for the role.
- Collaborates closely with Legal and Compliance teams to ensure risk initiatives align with regulatory standards and Aledade’s patient-first approach. Supports the development of condition suspecting strategies that enable timely and accurate diagnoses—improving patient outcomes and reducing total cost of care.
- Manages direct reports across multiple workstreams, which may include CDI, Risk Intervention Strategy (RIS), Performance, and Operations. Team assignments may evolve over time as organizational needs shift or as Aledade brings on additional leadership. Assigned teams reporting to Sr Director will be determined by experience of the hire and may evolve over time as more Aledade-experience is gained. If Aledade adds a VP of Risk Performance, shifting of which workstreams report to VP vs Sr Director is to be expected.
Minimum Qualifications:
- Bachelor’s degree in Healthcare Adm, Business or IT (or appropriate equivalent training and experience)
- 10+ years payer/healthplan/value based care company including Medicare and Commercial
- 7 + years Medicare risk adjustment including setting strategy for multiple Risk workstreams is a requirement, these may include CDI, IHAs, risk analytics, vendor decisions and management, suspect logic or other provider suggestion tools.
- Demonstrated, well-rounded experience supporting or leading Risk-based initiatives. .Demonstrated knowledge and experience with risk adjustment methodologies such as HCC, 3M, Milliman, etc.
- 7+ years of program management, project leadership and execution experience in a healthcare or product related setting.
- 7+ years of management experience
- Demonstrated customer-centric approach to work within experience
- Should be an agile user of Google Suites (or microsoft equivalent), analytical dashboards (such as Tableau), customer relationship management software (or other complex databases).
Preferred Qualifications:
- MBA, MHA or other Master’s level training in health, business or IT
- 10+ years of program management, project leadership and execution experience in a healthcare or product related setting.
- Demonstrated leadership ability in prior workplace, including running teams and managing a high profile portfolio, with internally and externally facing representation responsibilities
- Advanced Analytics: SQL, PowerBI, SAS
Physical Requirements:
- Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
- Travel: 10-25%
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What We Do
Aledade is the largest network of independent primary care, enabling clinicians to deliver better patient outcomes and generate more savings revenue through value-based care. Aledade’s data, personal coaching, user-friendly workflows, health care policy expertise, strong payer relationships and integrated care solutions enable primary care organizations to succeed financially by keeping people healthy. Together with more than 1,900 practices and community health centers in 45 states and the District of Columbia, Aledade manages accountable care organizations that share in the risk and reward across more than 200 value-based contracts representing more than 2.5 million patient lives. To learn more, visit www.aledade.com or follow on X (Twitter), Facebook or LinkedIn.
Why Work With Us
At Aledade, we’re all about doing good for patients, practices and society - which is why we’re so passionate about value-based care and the work we do every day. Because we’re working to benefit all of society, we believe the best way to do so is to utilize all of our team members and their unique experiences, interests, backgrounds and beliefs.
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