Head of Risk Business Management (f/m/d)

That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

We have an opportunity to join the Alliance as the Risk Adjustment Director leading the Risk Adjustment Department.

This position can be located in one of our service counties (Mariposa, Merced, Monterey, Santa Cruz, or San Benito) or remotely in California with expected travel to Alliance service area(s) once a quarter. Reporting to the Chief Financial Officer, you will:

Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance's Risk Adjustment Department functions

Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations

Direct, manage, and supervise Risk Adjustment Department staff

*This position will primarily focus on Medicare DSNP Risk Adjustment activities. The Alliance started the DSNP line of business in January 2026 and has approximately 1,000 members. We project the membership to grow to 3000 by the end of 2026.

The Finance Division acts as the guardian of the Alliance's financial health. We track the pulse of the organization by analyzing budgets, forecasting future performance, and navigating the ever-changing economic and political landscape.

To keep the Alliance financially strong and secure, we wear several hats and partner with every department in the organization to translate fiscal data into insights and action. From managing funds, to risk management, and compliance, we ensure the Alliance's responsible use of public funds.

A motivated and seasoned leader in the managed care industry, with expertise in risk adjustments

Excellent communication skills, with strength in building relationships and partnering with cross-functional teams.

Experience in overseeing the Medicare Risk Adjustment life cycle

Strong data and analytical skills, including SQL, dashboarding, and reporting

IPA/Medical Group experience highly desired

The managed care industry and of Medicare health insurance payment methodologies

Medicare (Hierarchical Condition Categories) risk adjustment models

Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations

Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers

Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types

Methods and techniques of valuating for physician and inpatient and outpatient hospital costs

Demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk

Perform complex analysis related to rate negotiations, health care cost reports, and determination of rates for hospitals, clinics, long-term care facilities, allied health services, professional services, and specialist services

Develop, plan, organize, and direct finance programs and activities that are complex in nature and regional in scope

Demonstrate a collaborative management style, build rapport, demonstrate excellent public relations skills, and effectively manage internal and external business relationships

Bachelor's degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field

A minimum of ten years of experience in healthcare finance or analytics, which included a minimum of five years of experience with Medicare risk adjustment processes, a minimum of two years of experience related to Medicare Managed Care Programs, and a minimum of three years of supervisory experience (a Master's degree may substitute for two years of general healthcare finance or analytics experience); We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.

While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.

In-office or in-community presence may be required for some positions and is dependent on business need. health, and a member from our Talent Acquisition team will be in touch.

Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.