The Role
Leads enterprise risk adjustment, clinical documentation improvement, provider engagement, coding, and population health programs. Oversees multiple leadership layers, cross-functional initiatives, budgets, vendors, regulatory compliance, audits, and performance improvement. Develops strategies supporting value-based care, risk capture, coding accuracy, provider performance, financial outcomes, and organizational growth. Builds leadership capability, manages geographically dispersed teams, and partners with executives, providers, health plans, compliance, analytics, quality, and finance stakeholders.
Summary Generated by Built In
We’re seeking a strategic healthcare operations leader to help take our Risk Adjustment organization to the next level. This role will focus on building structure, standardizing processes, developing leaders, and driving accountability across a complex, highly regulated, multi-market organization.
You’ll oversee multiple levels of leadership and partner closely with Clinical Operations, Quality, Network Management, Analytics, and executive leadership. You’ll translate organizational priorities into clear operational expectations while also identifying challenges and bringing solutions back to leadership.
The ideal candidate is a strong operator and people leader who can inherit an evolving organization, identify opportunities for improvement, establish scalable processes, and lead teams through change.
Deep Risk Adjustment expertise is preferred but not required. We’re equally interested in leaders with backgrounds in healthcare operations, quality, population health, managed care, or value-based care who have demonstrated success building teams and improving complex processes.
Deep Risk Adjustment expertise is preferred but not required. We’re equally interested in leaders with backgrounds in healthcare operations, quality, population health, managed care, or value-based care who have demonstrated success building teams and improving complex processes.
The right person will be structured, collaborative, comfortable with accountability, and capable of operating independently in an environment where there is significant opportunity to build and improve.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
Strategic Leadership
- Develop and execute enterprise-wide risk adjustment and documentation improvement strategies aligned with organizational and value-based care objectives.
- Establish departmental goals, key performance indicators (KPIs), and operational plans that drive measurable improvements in risk capture, coding accuracy, provider engagement, and financial performance.
- Identify opportunities to enhance revenue integrity, operational efficiency, and program effectiveness through innovative solutions and data-driven decision making.
- Provide leadership and guidance on emerging regulatory requirements, risk adjustment methodologies, and industry best practices.
Program Oversight
- Provide oversight of risk adjustment, coding, provider education, documentation improvement, retrospective review, and prospective outreach programs.
- Ensure consistent implementation of operational standards, workflows, and performance expectations across all markets and business units.
- Lead cross-functional initiatives involving clinical services, provider operations, analytics, quality, compliance, and finance teams.
- Monitor program outcomes and implement strategic improvements to maximize organizational performance.
Financial and Operational Management
- Accountable for achievement of risk adjustment, quality, productivity, compliance, and financial performance goals.
- Develop and manage departmental budgets, workforce planning, resource allocation, and vendor expenditures.
- Evaluate operational trends, performance metrics, and financial results to identify opportunities for growth and process improvement.
- Implement corrective action plans when performance objectives are not being achieved.
Provider and Stakeholder Management
- Build and maintain strategic relationships with executive leadership, provider groups, health plans, vendors, and external stakeholders.
- Partner with providers and operational leaders to support documentation excellence, coding accuracy, and value-based care success.
- Present business performance, strategic recommendations, and operational results to senior leadership and executive stakeholders.
- Oversee vendor management activities, including performance monitoring, contract compliance, and service delivery expectations.
Regulatory Compliance and Quality
- Ensure organizational compliance with CMS, NCQA, DMHC, HHS, and other applicable federal, state, and health plan requirements.
- Oversee internal monitoring, audits, and regulatory review activities related to risk adjustment and documentation practices.
- Collaborate with compliance and quality teams to implement corrective actions and continuous improvement initiatives.
- Promote a culture of ethical documentation, coding integrity, and regulatory compliance.
Leadership and Talent Development
- Provides direct leadership and oversight to Senior Managers, Managers, and departmental leadership teams responsible for risk adjustment operations, coding, provider engagement, analytics, and program administration.
- Establishes strategic direction, performance expectations, and operational priorities across multiple functional areas and levels of leadership.
- Coaches, mentors, and develops leaders to strengthen organizational capability, succession planning, and employee engagement.
- Evaluates organizational structure and staffing needs to ensure resources are appropriately aligned with business objectives and growth strategies.
- Drives a culture of accountability, collaboration, innovation, and continuous improvement throughout the department.
- Oversees talent management activities including recruitment, performance management, employee development, succession planning, and leadership development.
- Ensures consistency in management practices, employee engagement, and performance standards across all teams and markets.
- Partners with executive leadership to anticipate future workforce needs and develop organizational capabilities that support long-term strategic objectives.
- Other duties as assigned.
Qualifications
- Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Health Information Management, or related field required.
- Master's degree preferred.
- At least 10 years of healthcare operations, risk adjustment, managed care, or population health experience.
- At least 5 years of progressive leadership experience managing multiple teams or programs.
- Demonstrated experience leading large-scale value-based care or risk adjustment initiatives.
- One or more of the following certifications preferred: CRC, CPC, CCS, RHIA, RHIT
- Expert knowledge of CMS-HCC, Medicare Advantage, ACA, Medicaid, and value-based reimbursement methodologies.
- Strong understanding of risk adjustment operations, clinical documentation improvement, coding compliance, and healthcare analytics.
- Advanced knowledge of CMS, NCQA, DMHC, and other regulatory requirements impacting value-based care programs.
- Demonstrated ability to develop and execute strategic initiatives that improve organizational and financial performance.
- Strong business acumen, financial management, and operational leadership capabilities.
- Exceptional analytical and problem-solving skills with the ability to interpret complex healthcare data and translate findings into actionable strategies.
- Proven ability to influence and collaborate effectively with executive leaders, physicians, providers, and cross-functional stakeholders.
- Excellent verbal, written, presentation, and negotiation skills.
- Strong project management and change management capabilities.
- Experience leading large, geographically dispersed teams and complex healthcare programs.
Environmental Job Requirements and Working Conditions
- This is a remote position. Travel is required to provider offices across all of our US markets, health plan meetings organizational events, and to corporate offices in Southern California and Houston.
- The total compensation target pay range for this role is $160,000 - $195,000 per year. Total compensation will be evaluated based on experience, certifications, and skillsets.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Health Information Management, or a related field
- Master's degree
- At least 10 years of healthcare operations, risk adjustment, managed care, or population health experience
- At least 5 years of progressive leadership experience managing multiple teams or programs
- Experience leading large-scale value-based care or risk adjustment initiatives
- CRC, CPC, CCS, RHIA, or RHIT certification
- Expert knowledge of CMS-HCC, Medicare Advantage, ACA, Medicaid, and value-based reimbursement methodologies
- Strong understanding of risk adjustment operations, clinical documentation improvement, coding compliance, and healthcare analytics
- Advanced knowledge of CMS, NCQA, DMHC, and other regulatory requirements impacting value-based care programs
- Ability to develop and execute strategic initiatives improving organizational and financial performance
- Strong business acumen, financial management, and operational leadership capabilities
- Exceptional analytical and problem-solving skills, including interpreting complex healthcare data and translating findings into actionable strategies
- Ability to influence and collaborate with executive leaders, physicians, providers, and cross-functional stakeholders
- Excellent verbal, written, presentation, and negotiation skills
- Strong project management and change management capabilities
- Experience leading large, geographically dispersed teams and complex healthcare programs
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
