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Director Health Plan Risk Adjustment Jobs (NOW HIRING)

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with ... Job Profile JOB SUMMARY The Risk Adjustment Coder II provides advanced support for complex medical ...

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

Community is accredited by URAC for its health plan operations. We offer care management programs ... Job Profile JOB SUMMARY The Risk Adjustment Coder II provides advanced support for complex medical ...

Gfoat

Risk & Health Plan Manager

Longview, TX · On-site

... the City's Health Plan, the City's Wellness Plan and Health Clinic, employee benefits, risk ... Prepares and presents staff reports, studies, solutions, and/or courses of action to the Director ...

Hello Heart

Director, Health Plan Growth

$175K - $200K/yr

... risk up to 10 days in advance versus 10 years in traditional clinical models. This is already ... Searching for an energetic, assertive and results driven Sales Director, Health Plan Growth to join ...

Hello Heart

Director, Health Plan Growth

$175K - $200K/yr

Searching for an energetic, assertive and results driven Sales Director, Health Plan Growth to join our dynamic team of sales individuals. Reporting to the SVP of Health Plan Growth , you are ...

CommunityCare, Inc.

Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE * A minimum of two years of risk adjustment coding or auditing experience. * Experience reviewing medical records ...

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Director Health Plan Risk Adjustment information

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$54K

$143.2K

$260K

How much do director health plan risk adjustment jobs pay per year?

As of Sep 13, 2026, the average yearly pay for director health plan risk adjustment in the United States is $143,185.00, according to ZipRecruiter salary data. Most workers in this role earn between $105,500.00 and $167,500.00 per year, depending on experience, location, and employer.

What is the difference between Director Health Plan Risk Adjustment vs Health Plan Risk Adjustment Analyst?

AspectDirector Health Plan Risk AdjustmentHealth Plan Risk Adjustment Analyst
CredentialsTypically requires advanced degrees (e.g., Master’s), certifications like CPC, CRC, or RHIA, and extensive experienceOften requires a bachelor’s degree, certifications like CPC or CRC, and entry to mid-level experience
Work EnvironmentLeadership roles overseeing teams, strategy, and compliance within health plansData analysis, coding, and reporting tasks within health plan operations
Employer & Industry UsageUsed in health insurance companies, managed care organizations, and healthcare consulting firmsCommonly employed in health plans, healthcare providers, and analytics firms

The main difference is that the Director Health Plan Risk Adjustment holds a leadership role with strategic responsibilities, while the Health Plan Risk Adjustment Analyst focuses on data analysis and coding tasks. The director oversees teams and ensures compliance, whereas analysts support operational functions within the risk adjustment process.

What are popular job titles related to Director Health Plan Risk Adjustment jobs?

For Director Health Plan Risk Adjustment jobs, the most frequently searched job titles are:

Infographic showing various Director Health Plan Risk Adjustment job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 76% Full Time, 17% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $143,185 per year, or $68.8 per hour.

Specialist, Health Plan Provider Engagement

Seattle, WA • On-site

Molina Healthcare
Health Care and Social Assistance • 10K+ employees
Learn more about Molina Healthcareexternal

$83K - $101K/yr

Full-time

Medical

Re-posted 16 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

Job description


JOB DESCRIPTION Job Summary
Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and analytics. Drives value-based care strategies through risk adjustment and quality improvement activities. Focuses on smaller, less advanced Tier 2 and Tier 3 providers, ensuring they have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitate data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.
Essential Job Duties
  • Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
  • Ensures assigned Tier 2 and Tier 3 providers have a provider engagement plan to meet annual quality and risk adjustment performance goals.
  • Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item development, and execution.
  • Works with provider front-office staff to get the Molina members with the most open gaps on the schedule seen by their assigned provider. Coordinates with Health Plan Community and Member Engagement resources to drive supporting effort on the member side.
  • Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
  • Drives provider participation in Molina risk adjustment and quality efforts (e.g., supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal.
  • Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness both within and across Molina health plans.
  • Serves as provider engagement subject matter expert; works collaboratively with health plan and shared service partners to ensure alignment to business goals.
  • Collaborates with assigned health plan Provider Relations Network team member on operational, provider and member issues.
  • Accountable for use of standard Molina Provider Engagement reports and training materials.
  • Develops, organizes, analyzes, documents, and implements processes and procedures as prescribed by health plan and corporate policies.
  • Communicates comfortably and effectively with internal and external stakeholders, including physician leaders, providers, practice managers, and medical assistants within assigned provider practices.
  • Maintains the highest level of compliance.
  • May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.

Required Qualifications
  • At least 2 years of experience improving population-level HEDIS quality scores and burden of illness documentation accuracy through provider engagement, or equivalent combination of relevant education and experience.
  • Experience with various managed health care provider compensation methodologies including but not limited to fee-for service (FFS), value-based care (VBC), and capitation.
  • Working knowledge of quality metrics and risk adjustment practices across all business lines.
  • Knowledge and understanding of HEDIS/NCQA and/or CMS STARs quality measures and risk adjustment practices across Medicaid, Medicare, and Marketplace
  • Proficiency with data analysis, manipulation, interpretation, and reporting.
  • Critical-thinking, problem-solving, and analytical skills.
  • Relationship building skills.
  • Attention to detail and organizational skills.
  • Ability to implement process improvement initiatives and drive change.
  • Ability to work independently in a fast-paced, deadline-driven environment.
  • Ability to foster and build relationships in a cross-functional highly matrixed organization to obtain buy-in and drive results.
  • Effective verbal and written communication skills.
  • Microsoft Office suite (including Excel), Power BI, and other applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications
  • Bachelor's degree in Nursing, Health Administration or relevant discipline.
  • Solid understanding of health insurance, provider messaging/design, and project management
  • Strong experience using Microsoft products, including Excel (knowledge of pivot tables, VLOOKUP, etc.) and PowerPoint

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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