Aledade2mo ago

Vice President, Risk Adjustment, Remote

United States·ArlingtonRemoteFull Timeexecutive

OtherPresident

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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 compiling and utilizing data analytics to improve our communication to payers throughout the year on our initiatives in the Risk initiative space. This role will collaborate with Risk leaders across Product, Analytics and Provider Networks Performance, serving as a subject matter expert across multiple lines of business, advising on work in cross departmentally.

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 outcome-oriented 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 Aledade’s Strategy and Priority Leadership Team tasked with informing the company’s overall strategic direction.

Learns Aledade’s historical performance in the risk initiative, headwinds faced and overcome, and work in progress that drives risk performance. Uses that information to craft the messaging to external viewers (payer facing, Board facing) that they need to be updated on regularly: “How are we doing in Risk, and how are we doing it”. Priority is MSSP and MA contracts and payers, and commercial, exchange, CMMI programs and medicaid to be added to portfolio over time.

Is both a customer of and an advisor to teams from Payer Success, Provider Networks, Product and Analytics. data analysts, clinical documentation integrity specialists and coders, quality auditors and other relevant personnel, providing guidance and expertise on risk assessment methodologies.

Partner closely with tech-product-analytic teams to design and maintain sophisticated risk algorithms using patient demographics, clinical data, and other relevant factors to accurately identify high-risk 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.

Participates in compliance initiatives, serving as the primary liaison for all Compliance and Legal projects relevant to Payer Success and other departments. Cross-collaborates with Performance, Product adding an additional business perspective in compliance matters. Ensuring alignment with regulatory standards and organizational goals. Leverage experience in developing and executing compliance-driven programs to mitigate risk and drive organizational success.

Develop a roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.

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 re-submissions, etc.

Partner with clinical teams, care management, and leadership to effectively communicate risk assessments and implement targeted interventions based on risk stratification results.

Required: Bachelor’s Degree with 15+ years experience in healthcare. Ideal candidates will have a combination of senior-level experience and expertise in health care strategy, health plans, business development, management consulting, health care finance, and provider operations.

Preferred: Master’s 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 cross-functionally

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

Exceptional communication and organization skills

Project management experience

Systems-thinker (data management, software administration)

Experience developing educational tools/documentation

Passionate about healthcare and interested in making a positive impact in the field

A committed self-starter who is able to take initiative and ownership of projects

A collaborative team player

Detail oriented and self-motivated to produce work that meets high standards