Find & Apply For Risk Manager Jobs in Spring Hill, Florida

Director, Medicare Risk Adjustment Location:

Spring Hill, FL Work Arrangement:

On-Site Only (No Remote Work Available) About the Role Ultimate Health Plans is seeking a strategic and results-driven Director, Medicare Risk Adjustment to lead and optimize our Medicare Advantage Risk Adjustment program. This leadership role is responsible for developing and executing strategies that improve risk adjustment accuracy, financial performance, provider engagement, and regulatory compliance across our provider network. The ideal candidate will possess extensive Medicare Advantage experience, deep knowledge of CMS Risk Adjustment methodologies, and a proven ability to lead cross-functional teams while driving measurable performance outcomes. Key ResponsibilitiesStrategic Leadership Lead the overall Medicare Risk Adjustment strategy to maximize program performance and financial outcomes. Develop and implement initiatives that improve risk score accuracy, documentation quality, and coding compliance. Monitor, analyze, and report on Medicare Advantage performance metrics and financial results. Identify opportunities for improvement and implement action plans to achieve organizational goals. Provider Engagement & Education Serve as the primary point of contact for participating providers, physician groups, and Independent Practice Associations (IPAs) regarding risk adjustment performance. Conduct provider meetings and deliver education focused on documentation improvement, coding accuracy, and CMS compliance. Develop targeted provider education programs based on coding trends, audit results, and performance data. Foster strong relationships with providers and key stakeholders to support achievement of risk adjustment objectives. Coding, Compliance & Audit Management Ensure compliance with CMS Risk Adjustment regulations and guidelines. Partner with Risk Coding teams to validate diagnosis capture and accurate submission within CMS timelines. Audit provider documentation and ICD-10 coding practices to ensure compliance with CMS Risk Adjustment requirements. Lead coding audit activities, including RADV audits and corrective action initiatives. Oversee remediation efforts and resubmissions for failed CMS submissions when necessary. Protect the confidentiality of member information and maintain HIPAA compliance. Operational Excellence Collaborate with Quality, Compliance, Coding, Performance, and Clinical teams to achieve organizational objectives. Lead cross-functional projects and workgroups to support risk adjustment and Medicare Advantage performance goals. Identify operational efficiencies and implement process improvements. Manage timelines, deliverables, risks, and stakeholder communications across multiple initiatives. Required QualificationsEducation & Certifications Bachelor's degree required; Master's degree preferred. Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) certification required. Experience 5+ years of experience in Medicare Advantage, Risk Adjustment, or Health Plan Operations. 3+ years of leadership or management experience. Demonstrated success in Medicare Risk Adjustment and Quality programs. Knowledge & Skills Strong knowledge of CMS-HCC Risk Adjustment, Risk Adjustment Data Validation (RADV), and Medicare Advantage regulations. Understanding of HEDIS and healthcare quality programs. Working knowledge of ICD-10, CPT, and HCPCS coding systems. Experience with electronic medical records (EMR) platforms such as eClinicalWorks (eCW) and Athenahealth. Advanced proficiency in Microsoft Excel, Word, and PowerPoint. Strong analytical, organizational, and problem-solving skills. Excellent written, verbal, and presentation skills. Ability to manage multiple priorities in a fast-paced environment. Proven ability to build relationships and collaborate effectively with physicians, executives, and operational teams. Why Join Ultimate Health Plans? Opportunity to lead a high-impact Medicare Advantage Risk Adjustment program. Collaborative and mission-driven culture. Competitive compensation and benefits package. Ability to drive measurable outcomes that improve member care and organizational performance. Apply today if you're a Medicare Advantage Risk Adjustment leader who thrives on driving results, building provider partnerships, and ensuring coding excellence.

Job Type:

Full-time Pay:

From $85,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid time off Retirement plan Vision insurance

Experience:

Management:

1 year (Preferred)

Medicare Risk:

1 year (Preferred)

HEDIS:

1 year (Required) Managed care: 1 year (Required)

License/Certification:

RN License (Required) Ability to

Commute:

Spring Hill, FL 34606 (Required) Ability to

Relocate:

Spring Hill, FL 34606: Relocate before starting work (Required)

Work Location:

In person