Job Details

As a Director of Risk Adjustment Strategy and Performance you will:

• The Director of Risk Adjustment Strategy and Performance is a pivotal leadership role within Navvis. This position is responsible for driving the development, execution, and ongoing enhancement of risk adjustment programs.

• Success in this role requires deep expertise in both health plan and provider domains.

• The Director will focus on leveraging data and technology to design risk adjustment solutions that are scalable, efficient, and innovative. These efforts directly support the organization's mission to improve outcomes and enhance financial performance in the value-based care landscape.

A Day in the Life:

• Lead the end-to-end design, implementation, and optimization of comprehensive risk adjustment strategies across both health plan and provider partners in partnership with our Physician Executive. Ensure all initiatives are aligned with organizational goals and adhere to all applicable regulatory requirements.

• Employ advanced data analytics and reporting tools to identify improvement opportunities, continuously monitor program performance, and inform strategic decision-making processes.

• Develop and implement scalable processes and frameworks that can be efficiently deployed across diverse markets and client segments, supporting sustainable growth and driving operational excellence.

• Collaborate closely with technology teams to accelerate the adoption of innovative solutions, such as artificial intelligence, automation, and digital platforms. These efforts will enhance data collection, improve coding accuracy, and increase overall program efficiency.

• Serve as the organization's subject matter expert on risk adjustment methodologies, regulatory changes, and industry best practices. Provide guidance and educational support to both internal teams and external stakeholders as needed.

What Success Looks Like in this Role:

• Build and maintain strong relationships with health plans, provider organizations, and other strategic partners to maximize the impact of risk adjustment initiatives and advance value-based care success.

• Establish and manage enterprise-level key performance indicators (KPIs), dashboards, and automated reporting systems to monitor RAF/HCC capture, documentation accuracy, provider performance, and financial outcomes.

• Lead data-driven performance reviews, utilizing actionable insights to reallocate resources toward opportunities that offer the highest value.

• Measure and improve operational efficiency by evaluating turnaround time, cost per chart, provider burden, and yield per intervention, implementing strategies to enhance these metrics wherever possible.

Requirements

We are excited about you if you have these things:

• Bachelor's degree in healthcare administration, business, or a related field; a Master's degree is preferred.

• At least 10 years of experience in risk adjustment, with demonstrated leadership in both health plan and provider settings.

• Proven expertise in data analytics, program management, and implementing technology-driven solutions within risk adjustment or value-based care environments.

• Strong knowledge of CMS and commercial risk adjustment regulations, coding standards, and industry trends.

• Excellent communication skills, with the ability to collaborate and manage stakeholders effectively.

• Capacity to thrive in a fast-paced, innovative, and mission-driven environment.