Description
Medical Director, Risk Adjustment
Southern California preferred; Clark & Pima Counties, NV — Travel Required
CareMore Health
Make an Impact Where Precision Meets Purpose
CareMore Health is seeking a seasoned and mission-driven Medical Director, Risk Adjustment to join our expanding clinical leadership team. In this pivotal role, you won’t just advise from afar — you’ll partner closely with providers, coders, and cross-functional leaders to ensure the integrity, accuracy, and effectiveness of our risk adjustment strategy.
If you're a clinician who thrives on aligning clinical excellence with operational performance, and you understand how accurate documentation fuels both patient care and sustainable healthcare economics — this is your opportunity to lead.
What You’ll Do
Lead Clinical Risk Adjustment Strategy
- Guide CareMore’s enterprise approach to risk capture, ensuring full and accurate documentation of chronic conditions and patient complexity.
- Partner with leadership to define and monitor performance targets tied to risk adjustment and revenue integrity.
Educate and Engage Providers
- Design and deliver training programs that elevate provider understanding of HCC coding and documentation best practices.
- Serve as a visible champion for prospective risk capture at the point of care.
- Champion real-time documentation and coding accuracy during patient encounters.
- Serve as a trusted clinical advisor and educator for providers system-wide.
Analyze Data and Drive Performance
- Review documentation and coding data to identify gaps and guide provider interventions.
- Lead targeted improvement efforts that reduce audit exposure and enhance RAF accuracy.
- Collaborate with analytics to build dashboards and tools that visualize risk adjustment progress.
Foster Cross-Functional Integration
- Work closely with coding, compliance, analytics, and operations to embed risk adjustment strategy into broader CareMore and Mosaic Health initiatives.
- Align documentation initiatives with enterprise quality, value-based care, and financial goals.
Ensure Regulatory Compliance
- Ensure alignment with CMS, OIG, and RADV audit regulations.
- Maintain audit-ready documentation standards and support compliance response.
- Proactively adapt strategies to reflect changing regulatory guidance.
Qualifications
Education & Licensure
- MD or DO with active, unrestricted license.
- Board certification in Internal Medicine, Family Medicine, or related specialty preferred.
Experience
- 8+ years of clinical experience, including 3–5 years focused on risk adjustment, CDI, or value-based care.
- Proven track record leading provider education and risk documentation initiatives.
- Deep knowledge of Medicare Advantage and CMS risk adjustment (RAF, HCC, RADV).
Skills & Knowledge
- Expertise in clinical documentation, coding accuracy, and risk methodologies.
- Skilled in data interpretation and transforming insights into provider-level interventions.
- Strong communicator and collaborator across clinical and operational teams.
Reporting Structure
- Reports To: Vice President, Risk Adjustment & Quality (CareMore Health)
- Location: Southern California preferred; travel required to Tucson, AZ and Las Vegas, NV
How to Apply
Ready to make an impact? Submit your application and learn more about joining CareMore Health’s leadership team at:
https://verawholehealth.wd1.myworkdayjobs.com/en-US/External/details/Medical-Director---Risk-Adjustment_M101534?q=risk&source=Sky Advertising
About CareMore Health
With nearly 30 years of experience in providing advanced primary care, CareMore Health delivers exceptional patient experiences by putting people first. Through personalized, compassionate care, CareMore clinicians remove barriers to access and improve health outcomes — whether in our clinics, in the home, or virtually. As a part of Mosaic Health, we serve diverse communities with innovation, empathy, and an unwavering commitment to quality.
