Medicaid Risk Adjustment Program Management Lead Director

Position Summary Reporting to the Executive Director of Revenue Integrity (RI), the Lead Director – Revenue Integrity (Medicaid) drives segment-level performance across Medicaid risk adjustment and revenue integrity initiatives. The role leads strategic program execution, performance management, and data-driven decision-making to ensure complete, accurate, and compliant revenue capture in a highly matrixed environment. It partners with enterprise, regional, and market stakeholders to identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets. The Lead Director advances performance office governance, optimizes program effectiveness, and aligns with the enterprise revenue integrity strategy. Key Responsibilities Program Leadership & Governance (45%) – Lead executive and performance governance forums to proactively identify risks and performance gaps impacting revenue integrity outcomes. Design, implement, and continuously refine national Medicaid RI programs aligned to enterprise strategy and regulatory requirements. Partner with RI CoE leaders, clinical leadership, and network organizations to strengthen program effectiveness and drive measurable outcomes. Establish scalable processes, workflows, and operational frameworks to support program execution and sustainability. Lead and deliver high-impact strategic initiatives that improve revenue accuracy, compliance, and overall performance. Performance Analytics & Reporting (20%) – Partner with Informatics, Technology, and Performance Office teams to develop and operationalize robust performance reporting. Define and monitor key performance indicators (KPIs), leading indicators, and dashboards to drive actionable insights. Synthesize complex data into executive-level insights and recommendations. Ensure data integrity, reporting accuracy, and alignment across systems supporting Medicaid revenue integrity programs. Market Strategy & Performance (25%) – Provide strategic leadership and oversight of Medicaid market performance across regions. Collaborate with regional and local leaders to identify risks, remove barriers, and implement targeted interventions. Serve as a trusted advisor to market leadership, driving accountability for revenue integrity performance. Champion adoption of enterprise programs while tailoring strategies to local market dynamics. Talent Leadership & Organizational Development (10%) – Lead and develop a high-performing team with clear accountability for outcomes. Set performance expectations aligned with enterprise objectives and foster a culture of continuous improvement and innovation. Coach and mentor team members to build strategic, analytical, and leadership capabilities. Required Qualifications A minimum of 10 years of experience in Medicaid risk adjustment / revenue integrity. Demonstrated expertise in Medicaid regulatory requirements, including risk adjustment methodologies and encounter data processes. Proven ability to develop and execute strategic initiatives that deliver measurable business outcomes. Strong leadership capabilities with advanced problem‑solving and decision‑making skills in complex, matrixed environments. Experience leading large‑scale, cross‑functional programs with significant enterprise‑wide impact. Skilled at influencing senior stakeholders and driving change within highly regulated environments. Consistent attendance and flexibility to travel as required. Preferred Qualifications Master’s degree (e.g., MBA, MPH) or completion of a management development program. Deep understanding of enterprise Medicaid markets and state‑specific regulatory environments. Experience working within a large national health plan or payer organization. Prior experience in a highly matrixed, enterprise‑scale organization. Education: Bachelor’s degree preferred or a combination of professional work experience and education. Pay Range Typical pay range: $100,000.00 – $231,540.00. The base salary is determined by experience, education, geography, and other factors. The position includes eligibility for company bonus, commission, or short‑term incentive programs, plus an equity award program target. Benefits The role includes a comprehensive benefits package covering medical, dental, and vision; paid time off; retirement savings options; wellness programs; and additional resources based on eligibility. Details are provided during the application process. #J-18808-Ljbffr 4062 Aetna Resources, LLC