Director, Product Manager, Risk Adjustment

Role Description

Director, Product Manager - Risk Adjustment (Remote)

About the Role:

• Type: Full-Time, Salaried
• Compensation: $152,000-$183,000, 20% bonus
• Location: Fully Remote (must be located in the United States)
• Hours: Full-Time, Days

What to Expect:

• Building technology that helps clinicians tell a more complete patient story.
• Defining how data, clinical workflows, AI, interoperability, and mobile technology come together.
• Owning one of the most strategically important products in our portfolio.

What You'll Build:

• Lead product strategy for the technology that powers our Risk Adjustment ecosystem.
• Your mission centers around three product pillars:
• Enrich: Create the industry's most complete member health picture.
• Capture: Help clinicians document the right conditions the right way.
• Measure: Shape the future of clinically grounded, compliant, and member-centered risk adjustment.

You'll Be Responsible For:

• Defining and executing the product roadmap across prospective and retrospective risk adjustment workflows.
• Building scalable capabilities supporting Medicare Advantage (CMS-HCC), ACA Marketplace (HHS-HCC), and Medicaid risk adjustment models.
• Driving enhancements inside careflow™ that improve clinician experience and documentation quality.
• Partnering with Clinical, Coding Operations, Engineering, Compliance, Finance, Customer Success, and Executive Leadership.
• Translating evolving CMS regulations into product strategy.
• Leading build vs. buy decisions around AI-assisted coding, NLP, longitudinal patient records, audit analytics, and risk prediction platforms.
• Expanding interoperability through APIs, HIE integrations, and FHIR-enabled data exchange.
• Defining the analytics and reporting that demonstrate measurable client value.
• Representing Product with customers and helping shape the future roadmap through real-world feedback.

Qualifications

• 5+ years of Product Management experience.
• 2+ years working within healthcare payer, value-based care, or Risk Adjustment.
• Deep understanding of HCC coding and CMS Risk Adjustment models across Medicare Advantage, ACA, and Medicaid.
• Experience translating CMS regulatory changes into product strategy.
• Strong analytical skills with experience interpreting RAF performance, coding gaps, recapture metrics, encounter data, and operational KPIs.
• Familiarity with APIs, HIEs, FHIR, and healthcare interoperability.
• Demonstrated success leading highly cross-functional teams without direct authority.
• Confidence representing product strategy with customers and executive stakeholders.

Requirements

• Experience with AI or NLP-assisted coding platforms (Optum, Apixio, Episource, Veradigm, etc.).
• Clinical Documentation Improvement (CDI).
• Provider query workflows.
• HEDIS or Star Value-Based Care organizations.
• Longitudinal patient data platforms.
• In-home clinical services.

Benefits

• Medical, dental, vision.
• Paid time off, paid holidays.
• 401(k) with company matching.
• Voluntary life insurance.
• Short-term disability, long-term disability.
• Employee assistance program.
• Health savings account, flexible spending accounts, and additional voluntary benefits.