Vice President, Risk Adjustment, Remote

The Vice President of Risk Stratification plays a critical role in shaping and implementing a strategic approach to risk stratification. This senior leadership position focuses on compiling and utilizing data analytics to improve our communication to payers throughout the year on our initiatives in the Risk initiative space. This role will collaborate with Risk leaders across Product, Analytics and Provider Networks Performance, serving as a subject matter expert across multiple lines of business, advising on work in cross departmentally.

This senior leader will demonstrate strength in provider engagement, payment and risk sharing models, collaborative care models, data/analytics support, member engagement, health improvement and management programs, as well as collaboration with vendor partners to achieve identified goals.

This autonomous and outcome-oriented role requires strong leadership in influencing internal and external stakeholders, fostering alignment, and driving meaningful change in the way healthcare is delivered. Additionally, the Vice President of Risk Stratification contributes to Aledade's Strategy and Priority Leadership Team tasked with informing the company's overall strategic direction.

Primary Duties:

• Learns Aledade's historical performance in the risk initiative, headwinds faced and overcome, and work in progress that drives risk performance. Uses that information to craft the messaging to external viewers (payer facing, Board facing) that they need to be updated on regularly: "How are we doing in Risk, and how are we doing it". Priority is MSSP and MA contracts and payers, and commercial, exchange, CMMI programs and medicaid to be added to portfolio over time.
• Is both a customer of and an advisor to teams from Payer Success, Provider Networks, Product and Analytics. data analysts, clinical documentation integrity specialists and coders, quality auditors and other relevant personnel, providing guidance and expertise on risk assessment methodologies.
• Partner closely with tech-product-analytic teams to design and maintain sophisticated risk algorithms using patient demographics, clinical data, and other relevant factors to accurately identify high-risk patients across different patient populations.
• Collaborate with the Analytics team to consume all available data sources from health plans, analyze large datasets and extract meaningful insights and identify trends related to patient risk profiles.
• Participates in compliance initiatives, serving as the primary liaison for all Compliance and Legal projects relevant to Payer Success and other departments. Cross-collaborates with Performance, Product adding an additional business perspective in compliance matters. Ensuring alignment with regulatory standards and organizational goals. Leverage experience in developing and executing compliance-driven programs to mitigate risk and drive organizational success.
• Develop a roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.
• Track key performance indicators (KPIs) across all contracts related to risk stratification, including # visits, RAF score, complete and accurate diagnosis coding to the highest degree of specificity, thorough and accurate documentation, and where appropriate, diagnoses recapture rates, diagnoses re-submissions, etc.
• Partner with clinical teams, care management, and leadership to effectively communicate risk assessments and implement targeted interventions based on risk stratification results.

Minimum Qualifications:

• Required: Bachelor's Degree with 15+ years experience in healthcare. Ideal candidates will have a combination of senior-level experience and expertise in health care strategy, health plans, business development, management consulting, health care finance, and provider operations.
• Preferred: Master's degree or other advanced degree(s) in business, health administration and/or public policy, or other relevant fields.
• 5+ years of successfully leading and executing a comprehensive Risk Stratification program at scale
• Required: Deep knowledge of Risk Stratification in Medicare Advantage and Commercial (ACA, HMO, PPO) plans are required. Preferred: Knowledge of MSSP and Medicaid.
• Proven track record of working collaboratively with clinical and operational colleagues across the organization as well as deep experience leading teams, managing projects, and driving strategic initiatives
• Deep understanding of healthcare terminology, clinical conditions, and disease progression
• Ability to manage multiple deadlines
• Ability to communicate complex data insights effectively and sensitively to diverse stakeholders, including clinicians, executives, regulatory bodies, and care teams in stressful situations
• Ability to lead by influence to engage colleagues and lead teams cross-functionally
• Proficiency in data analysis techniques, statistical modeling, and predictive analytics
• Familiarity with data warehousing, data mining tools, and healthcare information systems
• Experience in fostering networks internally and externally

Preferred Qualifications:

• Exceptional communication and organization skills
• Project management experience
• Systems-thinker (data management, software administration)
• Experience developing educational tools/documentation
• Passionate about healthcare and interested in making a positive impact in the field
• A committed self-starter who is able to take initiative and ownership of projects
• A collaborative team player
• Detail oriented and self-motivated to produce work that meets high standards
• Google Suite, particularly Google Sheets and Google Slides
• Tableau
• General Skills at data visualization

Physical Requirements:

• Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.

Who We Are:

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

What Does This Mean for You?

At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.

In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:

Flexible work schedules and the ability to work remotely are available for many roles

Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners

Robust time-off plan (21 days of PTO in your first year)

Two paid volunteer days and 11 paid holidays

12 weeks paid parental leave for all new parents

Six weeks paid sabbatical after six years of service

Educational Assistant Program and Clinical Employee Reimbursement Program

401(k) with up to 4% match

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And much more!

At Aledade, we don't just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.

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