Director of Quality and Risk Adjustment

We are currently hiring a **Director of Quality and Risk Adjustment!** If you are an **analytical healthcare leader, quality improvement champion, relationship builder, and value being part of a team that makes a difference**, you may be the right person for the position! **Apply today!** **Classification:** EXEMPT | **Status & Schedule:** FULL-TIME, MONDAY – FRIDAY, 8AM – 5PM **Location:** HYBRID/ONSITE, this position works remotely and reports to the Coos Bay Office location; travels frequently around Coos and Curry counties **Salary:** $4,230.77 - $5,769.23/BI-WEEKLY **Department:** QUALITY | **Reports to:** CHIEF COMPLIANCE & QUALITY OFFICER | **Supervision Exercised:** QUALITY STAFF OVERSIGHT **Job Purpose: Director of Quality and Risk Adjustment** The Director of Quality and Risk Adjustment provides strategic leadership for the development, implementation, oversight, and continuous improvement of organizational quality, risk adjustment, population health, and performance improvement programs. This position is responsible for establishing quality and risk adjustment frameworks, monitoring organizational performance, ensuring compliance with regulatory and contractual requirements. The Director collaborates with leadership, providers, and cross-functional teams to improve member outcomes, support value-based care initiatives, enhance revenue integrity, and drive organizational performance through data-informed decision making. **Qualifications, Education, & Experience** - Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, Health Information Management, or a related field required - Master’s degree in relevant field strongly preferred - Minimum of five years of progressively responsible leadership experience in healthcare quality improvement, performance improvement, risk adjustment, managed care, value-based payment models, or related healthcare operations - Three to five years’ experience in Medicaid risk adjustment and coding experience - Minimum three years’ experience in a medical office, clinic or healthcare administration setting - Track record of success providing training, education, and guidance to providers and clinical staff - Experience leading, training, and managing a team - Certified Professional Coder or Certified Risk Adjustment Coder, willing to obtain within the first year of hire **Essential Responsibilities:** Director of Quality and Risk Adjustment **Strategic Leadership and Program Development** 1. Develop and execute the organization's strategic vision for quality improvement, risk adjustment optimization, and performance improvement initiatives. 2. Provide leadership in the design, implementation, evaluation, and continuous improvement of organizational quality and risk adjustment programs. 3. Establish departmental goals, objectives, key performance indicators, and performance improvement strategies aligned with organizational priorities. 4. Serve as a strategic advisor to executive leadership regarding quality outcomes, risk adjustment performance, population health, healthcare transformation, value-based reimbursement and regulatory requirements. 5. Identify emerging trends, risks, opportunities, and best practices and develop proactive strategies to support organizational success. 6. Foster a culture of continuous quality improvement, innovation, accountability, and data-driven decision-making throughout the organization. 7. Collaborate with executive leadership, providers, vendors, community partners, and stakeholders to advance organizational quality and risk adjustment initiatives. **Quality Management** 1. Provide oversight and direction of the Quality Management Improvement (QMI) Program, Transformation and Quality Strategy (TQS), Performance Improvement Projects (PIPs), and related quality initiatives. 2. Ensure the development, implementation, and monitoring of quality improvement strategies that support contractual obligations, regulatory r…