Vice President Director Medicare Risk Adjustment Jobs

Optum NY, is seeking a Vice President of Quality Performance & Risk Adjustment to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live.  

 
As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

 
At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be whileCaring. Connecting. Growing together.  

The Vice President of Quality Performance & Risk Adjustment, Optum Health East is a senior executive responsible for the strategic design, execution, and continuous improvement of enterprise-wide quality, risk adjustment, and value-based performance initiatives across a large multi-state, risk-bearing healthcare organization. This role oversees performance for both employed and contracted provider networks and plays a critical role in building, strengthening, and sustaining trusted business partnerships with provider groups and key internal and external stakeholders.

The VP serves as a connector between clinical operations, provider organizations, health plans, and enterprise leaders-ensuring alignment between quality outcomes, accurate risk capture, regulatory compliance, and financial performance under all payer value-based contracts including Medicare Advantage, Commercial, Medicaid, etc.

This role is pivotal in aligning providers, health plans, and enterprise stakeholders around shared accountability for outcomes. By building strong business partnerships, integrating quality and risk operations, and translating strategy into measurable results, the VP ensures sustainable success in value-based, risk-bearing models across diverse markets.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:  

• Provider Partnership & Stakeholder Engagement
  • Serve as a senior relationship leader for multiple Optum East employed provider organizations, fostering collaborative, trust-based partnerships focused on shared outcomes
  • Act as a strategic advisor to physician leaders, medical directors, and practice executives on quality, risk adjustment, and value-based performance for both employed and contracted networks
  • Co-develop performance improvement plans with provider groups that balance quality outcomes, financial sustainability, and provider experience
  • Partner with network management and contracting teams to align quality and risk expectations within participation agreements and value-based contracts
  • Lead joint operating forums, governance committees, and performance reviews with provider partners
  • Build strong cross-functional partnerships with population health, care management, network operations, finance, actuarial, compliance, IT, and health plan stakeholders
• Enterprise Quality Strategy & Performance
  • Develop and execute a comprehensive, multi-year quality strategy aligned with organizational growth, provider network strategy, and value-based care objectives across all value-based contracts
  • Drive performance improvement across HEDIS, CMS Star Ratings, clinical outcomes, patient experience (CAHPS), and state-specific quality measures across multiple payers
  • Establish standardized yet flexible quality frameworks that can be adopted across diverse, multi-state provider groups
  • Partner with provider leadership to translate quality goals into practical, operational workflows
  • Partner with relevant national teams in quality, risk performance, IT, etc. to develop and monitor performance goals
  • Serve as a senior leader in reporting quality and risk performance in CDO, East regional, and national meeting forums
  • Serve a leader in quality incentive payment strategy across IPA network and employed CDOs
• Risk Adjustment & Coding Excellence
  • Lead enterprise risk adjustment strategy focused on accurate, compliant documentation and coding across employed and contracted providers
  • Partner with provider groups to embed risk capture best practices into clinical workflows
  • Oversee prospective and retrospective risk adjustment programs, chart reviews, and analytics
  • Ensure audit readiness and compliance with CMS, HHS, and state regulatory requirements
• Operational Integration & Efficiency (Quality Risk)
  • Design and lead an integrated operating model that aligns quality improvement and risk adjustment functions to reduce duplication, streamline workflows, and improve outcomes
  • Identify and eliminate inefficiencies across chart abstraction, gap closure, coding, and outreach activities to create a more cohesive provider experience
  • Standardize workflows, tools, and field resources (e.g., practice engagement, coding support, quality outreach) to present a unified approach to providers
  • Drive alignment of annual planning cycles, campaign calendars, and provider touchpoints across quality and risk programs
  • Implement shared performance metrics, dashboards, and accountability structures that reflect combined quality and risk outcomes
  • Partner with IT and analytics teams to integrate data platforms, reporting, and work queues to enable real-time, actionable insights
  • Ensure field teams and provider-facing resources are coordinated, minimizing provider abrasion and maximizing efficiency and impact
• Value-Based Care & Population Health Integration
  • Align quality and risk adjustment strategies with population health initiatives, care management programs, and utilization management efforts
  • Support performance under shared savings, capitation, and global risk arrangements
  • Collaborate with finance and actuarial teams to model, forecast, and track the financial impact of quality and risk initiatives
  • Ensure providers understand how quality and risk performance directly influence total cost of care and incentive outcomes
• Regulatory Compliance & Audit Oversight
  • Ensure enterprise-wide compliance with federal and state quality and risk adjustment regulations
  • Partner closely with compliance and legal teams to manage audits, corrective action plans, and ongoing monitoring
  • Serve as an executive point of contact for quality and risk-related regulatory interactions
• Data, Analytics & Performance Transparency
  • Champion transparent, actionable reporting that enables providers and stakeholders to understand performance drivers
  • Establish dashboards and reporting tools tailored to executive leaders, provider groups, and frontline clinicians
  • Leverage predictive analytics to identify high-risk populations, care gaps, and documentation opportunities
• Team Leadership & Organizational Development
  • Build, mentor, and lead high-performing teams across quality improvement, risk adjustment, coding, analytics, and provider engagement
  • Foster a culture of partnership, accountability, and continuous improvement
  • Ensure teams are equipped to support diverse provider models across multiple states

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:  

• 10 years of progressive leadership experience in healthcare quality, risk adjustment, population health, or value-based care
• Experience managing performance across varied networks (i.e, multi-payer, risk and non-risk, employed and independent)
• Experience with regulatory audits, compliance programs, and performance improvement planning
• Demonstrated success partnering with physician groups and provider organizations in risk-bearing arrangements
• Deep expertise in HEDIS, CMS Star Ratings, CAHPS, and value-based performance models
• Solid understanding of CMS-HCC and/or state risk adjustment methodologies, ICD-10 coding, and documentation standards
• Working knowledge of provider contracting, incentive design, and governance structures

Preferred Qualifications:  

Leadership & Relationship Competencies:

• Exceptional relationship-building and influence skills with physicians, executives, and external partners
• Ability to balance enterprise priorities with provider realities to create win-win solutions
• Strategic, systems thinker with strong operational execution capabilities
• Clear, credible communicator able to translate complex data into meaningful action

Key Performance Indicators (KPIs):

• Quality performance (Stars, HEDIS, clinical outcomes)
• Risk Adjustment Factor (RAF) accuracy and sustainability
• Provider engagement and satisfaction
• Reduction in performance variation across provider groups
• Financial outcomes under value-based contracts
• Audit results and compliance metrics
• Demonstrated reduction in operational redundancy and improved efficiency across quality and risk programs

 
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

  
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.    

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.