Lead, Organic Risk Adjustment

Become a part of our caring community We are seeking a Lead, Organic Risk Adjustment to build, operationalize, and scale our Organic Risk Adjustment program. This is not a role focused primarily on setting strategy from the sidelines. We're looking for a builder and a doer someone who enjoys rolling up their sleeves, creating processes from the ground up, solving operational challenges, and driving results through execution.

The ideal candidate is equally comfortable analyzing data, developing provider outreach plans, creating workflows, facilitating meetings, and following through on implementation. This role will work closely with clinical, operational, and analytical partners to improve documentation accuracy, risk capture, and overall program performance.

Success will come from the ability to turn ideas into action and build sustainable processes that create measurable impact. Key Responsibilities Program Development & Execution Build and operationalize programs that improve organic risk adjustment performance.

Develop workflows, playbooks, provider engagement approaches, and reporting processes from the ground up. Identify opportunities, create action plans, and personally drive implementation through completion. Manage multiple initiatives simultaneously, ensuring deliverables are completed on time and produce measurable results.

Serve as the point person for day-to-day execution of Organic Risk Adjustment initiatives. Provider & Operational Partnership Partner directly with providers, practice leaders, operations teams, and clinical stakeholders to improve documentation and coding performance.

Create practical solutions that fit within existing clinical workflows. Lead meetings, track action items, and ensure accountability across stakeholders. Analytics & Performance Improvement Analyze data to identify documentation and risk capture opportunities.

Translate insights into operational actions and measurable performance improvement. Monitor outcomes and adjust programs based on results. Use your skills to make an impact Required Qualifications Bachelor’s degree or equivalent experience 6+ years of related lead level experience Experience in Medicare Advantage risk adjustment, RAF performance, clinical documentation improvement, coding, quality, or value-based care operations.

Demonstrated ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational stakeholders. Experience developing provider education, documentation improvement strategies, and performance feedback processes.

Ability to analyze data trends, identify root causes, and translate insights into operational action plans. Strong communication, facilitation, and stakeholder management skills. Ability to manage multiple priorities in a fast-paced, highly regulated healthcare environment.

Preferred Qualifications Experience leading organic or prospective risk adjustment programs. Experience with provider-facing documentation workflows, EMR-based interventions, suspect condition programs, or point-of-care gap closure strategies.

Experience developing dashboards, executive reporting, or performance scorecards. Knowledge of Medicare Advantage operations, quality programs, Stars, care management, and value-based payment models. Prior people leadership or matrixed team leadership experience.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.

The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan.

This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.

Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 08-04-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.

These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.

It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.

This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.