Associate Director of Risk Adjustment and Quality – Denver, CO

UnitedHealth Group
July 17, 2021
Denver, CO
Job Type


Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Associate Director of Operations, Risk Transformation reports to the Vice President (“VP”) of Medical Management, ACO, Risk and Quality. Working under the direction of the VP and matrixed to market CMO and/or Medical Director(s) responsible for Risk Adjustment Strategies, CDQI and/or Quality, the Triad is responsible for Risk Adjustment Strategies and Quality/HEDIS Programs for the CO Market with shared accountabilities for identifying and driving overall strategies, execution and operational tactics that support the achievement of HEDIS/Quality market goals. Additionally, the Triad will work with and serve as subject matter experts for practice leaders, including the IPA, physician/provider leaders and risk transformation leaders, to ensure that practices/providers have a clear understanding of risk adjustment payer requirements, HEDIS/STARS/Commercial Payer Performance goals, KPIs and Performance Improvement Plans. The (Associate) Director is responsible for the overall management of all functions of the Risk, HCC Coding Education and Quality Teams including budget, departmental goals, manager development and team engagement. Position will serve as the point of contact on behalf of the Optum Colorado with National Coding Teams and Related Service Vendors, such as House Calls.  

Primary Responsibilities:

  • Shares accountability for delivering on service excellence, improving quality outcomes, ensuring HEDIS / Quality gaps are closed, improving / implementing successful HCC Coding Strategies and design/execution of strategies to ensure Annual Wellness Visit/Comprehensive Wellness Visits exceeds goals. Responsible to meet KPIs, including data analytics and action / process improvement activities. Shares accountability for achievement of quality and financial goals for the Market
  • Operational Project Management of programs related to Medicare Risk Adjustment. Defines, leads, implements, and measures processes from start to finish to ensure success criteria is achieved. Recommends and/or develops processes, workflows, and programs to achieve strategic initiatives.  Monitors and reports on departmental activities. Engages in continuous improvement with teams
  • Oversees clinical and operational programs to support comprehensive, value-based patient care. 
  • Leads the development and implementation of programs designed to support patient engagement, outreach, care delivery and provider education to ensure properly supported by appropriate clinical documentation
  • Collaborate with clinical and operational leadership to ensure alignment and partnership across Risk Adjustment initiatives. Facilitates the communication of results, risks, and opportunities to leaders / teams and a wide range of stakeholders. Initiates organizational and system changes enacting action plans to improve performance in collaboration with CMO and Medical Directors
  • Interfaces with operational leadership to assist in identification of operational and clinical best practices and strategic initiatives. Coordinates the dissemination of best practices to sites, clinicians, and support teammates. Develops and maintains operational workflows and timelines
  • Monitors clinician chart audit activities and coordinates operational aspects of clinical chart reviews, including identifying and data mining patient lists, coordinating chart provisions with reviewers, communicating results to rendering physicians and tracking and analyzing findings
  • Develops and implements policies and procedures as it relates to Medicare Risk Adjustment and Risk Adjustment activities
  • Conducts Risk Adjustment research. Prioritizes studies and provides analytical support through patient and clinical data to monitor performance, validate outcomes, and identify improvement opportunities that can be leveraged strategically, clinically, or operationally. Position will lead / partner with Risk Transformation leaders to ensure cross functional departmental meetings with Coding, Quality Manager, HCC Educator, Risk Transformation, Operations Directors and CMO / Medical Director on bi-weekly basis to design strategies/review data and develop and or update strategies. This position is expected to site visit practices and engage in operations meetings as requested
  • Partners with VP of Payer Strategies regarding shared and risk-based incentive program design.  Attends Commercial Insurance and Stakeholder Joint Operating Council meetings
  • Develops strategies and programs to ensure success in shared saving and risk-based incentive contracting related to risk adjustment and quality metrics
  • Manages relationships and partners with payors and external vendors as needed to support Risk Adjustment activities 
  • Engages with The Group’s National Clinical Performance Team to share and implement best practices related to Risk Adjustment activities and establish cross market goals
  • Effective communicator who can develop and present executive level materials to senior audiences
  • Aids in the execution of risk adjustment strategic vision by collaborating with team to set annual goals and outlines plans to achieve those goals
  • Stays appraised of and advises leadership of new requirements impacting internal risk adjustment activities and quality programs and incorporates changes as necessitated by Medicare, Commercial and other governmental payers
  • Ensure compliance with Company Healthcare Policies & Procedures and state and federal regulations / standards
  • Works in alignment with Patient Experience and Market in collaboration to ensure STARS Performance goals are achieved
  • Ability to travel required. Valid driver’s license, insurance, and vehicle for needed for work-related travel
  • Coordinate or perform projects / activities as delegated by organizational committees and VP

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:

  • Bachelor's degree from a 4-year college
  • 7+ years of health care experience to include 4+ years in healthcare management
  • Ambulatory care and/or primary care experience
  • Experience in a medical group, IPA, or HMO / value-based payer setting
  • Experience with Lean Management
  • BI and/or Tableau platforms experience
  • Knowledge and experience in data analysis, financial analysis, and medical review
  • Knowledge and experience in quality assessment and improvement programs
  • Knowledge and experience in the development and administration of managed care principles and practices
  • Computer literate; Proficient in Microsoft Office applications

Preferred Qualifications:

  • Master's Degree, MBA
  • Certified Coder

Knowledge, Skills, Abilities:

  • Excellent planning and organization, critical thinking, and decision-making skills
  • Inspires change to improve results, organizational success, efficiencies to reach organizational Quadruple goals
  • Result oriented with proven leadership and staff development skills
  • Strong analytical skills possess ability to review and manipulate data to draw conclusions
  • Excellent written and verbal communications skills; Able to communicate effectively with team members and leaders at all levels, with physicians, and with various categories of customers
  • Work cooperatively and collaboratively with peers and subordinates
  • Sound negotiation and conflict resolution skills
  • Project management skills with the ability to multi-task, set priorities and accomplish assignments
  • Work effectively with analytical tools, spreadsheets, and instructional tools
  • Develop, implement, and monitor processes to effectively uphold standards of care, policies, and procedures

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Job Keywords: Associate Director of Risk Adjustment and Quality, Denver, CO, Colorado

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