Director, Risk Adjustment

Interwell Health is a kidney care management company that partners with physicians on its mission to reimagine healthcare—with the expertise, scale, compassion, and vision to set the standard for the industry and help patients live their best lives. We are on a mission to help people and we know the work we do changes their lives. If there is a better way, we will create it. So, if our mission speaks to you, join us!

What You’ll Do

The Director of Risk Adjustment is a strategic operational leader responsible for driving risk adjustment performance across Interwell Health’s payer and government programs. The Director will serve as a central leader in advancing Interwell’ s risk adjustment capabilities, with accountability for both execution and measurable results in a highly regulated environment. The Director will translate organizational strategy into scalable programs and support cross-functional teams across clinical, coding, analytics, and provider engagement.

As the Director of Risk Adjustment, you will provide operational support, driving day-to-day operations, implementing new pilots, and running existing programs. In this role, you will play a critical part in assessing the opportunity for performance improvement, devising the approach for implementation of new strategies, and managing deployment of performance related initiatives for Nephrology providers.

Essential Functions:

Enterprise Strategy & Organizational Leadership

• Lead the development and execution of enterprise-wide risk adjustment strategy aligned to clinical, operational, and financial priorities

• Translate organizational goals (e.g., RAF improvement, recapture performance, coding accuracy) into actionable, scalable programs

• Partner with executive leadership to align risk adjustment priorities across Medicare Advantage, CKCC, and commercial populations

• Drive innovation and continuous improvement through advanced analytics, AI/NLP, and point-of-care enablement

Three-Pronged Risk Adjustment Approach

This role is accountable for designing and executing a comprehensive risk adjustment strategy anchored in three core pillars:

• Patient-Level Tracking: Build and operationalize longitudinal tracking of all suspected and recaptured conditions at the patient level—creating enterprise visibility comparable to medical cost tracking and enabling proactive management of coding gaps

• Data Enrichment: Leverage analytics, predictive modeling, and external vendor partnerships to enhance suspecting logic, improve data completeness, and increase targeting precision

• Execution Beyond Nephrology: Expand risk adjustment execution beyond nephrology by developing scalable processes to engage primary care providers (PCPs), health plans, and in-home programs to ensure comprehensive gap closure across the full continuum of care

Performance Ownership & Outcomes

• Establish KPIs, dashboards, and reporting cadences to ensure transparency and accountability

• Translate performance into financial impact (e.g., PMPM, revenue lift) for executive and board-level communication

• Identify risks to performance and implement mitigation strategies.

• Own and drive performance against key risk adjustment metrics, including:

• RAF accuracy and trend performance

• Recapture rates and gap closure

• Coding accuracy and audit outcome

What You’ll Need:

Skills & Competencies:

Cross-Functional Leadership

• Serve as a central leader across clinical operations, analytics, product, compliance, and finance

• Partner with analytics teams to refine suspecting models and performance measurement

• Collaborate with clinical and provider-facing teams to embed risk adjustment into workflows at the point of care

• Influence product and technology roadmaps (e.g., Epic integration, documentation tools)

Team Leadership & Development

• Lead and develop a high-performing team responsible for risk adjustment operations and delivery

• Establish clear goals, accountability, and performance expectations aligned with enterprise priorities

• Foster a culture of ownership, continuous improvement, and compliance

Compliance & Audit Readiness

• Ensure all risk adjustment activities meet CMS, payer, and regulatory requirements

• Partner with compliance to mitigate risk and maintain coding integrity

• Promote a culture of accurate, ethical, and defensible documentation

Education and Experience:

Required

• 8–12+ years of experience in risk adjustment, healthcare operations, or related field

• Deep expertise in Medicare Advantage risk adjustment, HCC coding, and RAF methodology

• Experience leading enterprise or multi-market risk adjustment programs (MA, CKCC, Commercial preferred)

• Proven ability to translate strategy into execution and measurable outcomes

• Strong financial acumen with ability to connect RAF performance to revenue impact

• Demonstrated success leading cross-functional initiatives in complex healthcare environments

• Experience building and leading high-performing teams

Preferred

• Bachelor’s degree in related field of study

Travel Requirements:

• Up to 25% travel required.

Work Environment:

• 100% Remote

Our mission is to reinvent healthcare to help patients live their best lives, and we proudly live our mission-driven values:

• We care deeply about the people we serve.

• We are better when we work together.

• Humility is a source of our strength.

• We bring joy to our work.

• We deliver on our promises.

We are committed to diversity, equity, and inclusion throughout our recruiting practices. Everyone is welcome and included. We value our differences and learn from each other. Our team members come in all shapes, colors, and sizes. No matter how you identify your lifestyle, creed, or fandom, we value everyone's unique journey.

Oh, and one more thing … a recent study shows that men apply for a job or promotion when they meet only 60% of the qualifications, but women and other marginalized groups apply only if they meet 100% of them. So, if you think you’d be a great fit, but don’t necessarily meet every single requirement on one of our job openings, please still apply. We’d love to consider your application!

Come join us and help our patients live their best lives. Learn more at www.interwellhealth.com.

It has come to our attention that some individuals or organizations are reaching out to job seekers and posing as potential employers presenting enticing employment offers. We want to emphasize that these offers are not associated with our company and may be fraudulent in nature. Please note that our organization will not extend a job offer without prior communication with our recruiting team, hiring managers and a formal interview process.