Senior Vice President, National Risk Adjustment Strategy

4 weeks ago

Oakland, United States Kaiser Permanente Full time
Job Summary:

The SVP, Risk Adjustment Strategy will have accountability for the strategic vision, multi-year roadmap, and operational execution of Kaiser Permanente’s quality-oriented risk adjustment programs and establishing a value-based Center of Excellence for this work at the National Health Plan level.



Essential Responsibilities:

  • Strategy and Vision:

    • This role will require a comprehensive understanding of the regulatory and compliance environment, the intersection of risk adjustment with clinical and quality programs, and an understanding of the best-in-class and innovative technology and tools available in the market upon which to build this foundation, including driving the appropriate business cases to achieve that objective.
    • It will further require an understanding of the provider value-based landscape, clinical workflows and tools, and the data analytics necessary to work collaboratively and transparently with our physician partners.
    • It will necessitate an understanding of how patient population prevalence and acuity influence and inform product development, growth, and retention strategies.
    • This role will work across the Kaiser Permanente organization and with external delivery system partners in a systems-oriented approach to ensure that clinical quality, financial sustainability, and regulatory goals are achieved in the most accurate and compliant manner.


  • Clinical Data Integrity and Accuracy:

    • This role will be accountable for the overall quality of the clinical data that we submit to our regulator and Commercial customers for risk adjustment, partnering with our physicians, clinicians, and coding professionals, along with data analytics, revenue cycle, and compliance support teams.
    • This will consist of training and education, coding integrity and continuous quality improvement feedback, concurrent and retrospective review processes, and comprehensive data analytics of submission and feedback files from regulators and customers.
    • This role will also ensure that source systems and data warehouses, as applicable, are updated to reflect the most accurate information about a patient record.


  • Risk Stratification and Prospective Algorithms to Determine Patient Risk:

    • Evaluate and implement analytical and predictive tools for improving identification of care gaps and promoting comprehensive care.
    • This role will work collaboratively across the National Health Plan, Care Delivery, and the Permanente Medical Groups to align on both strategy and execution of that data to inform clinical, quality, and operational performance levers.


  • Clinical Program Development and Quality Strategy:

    • This role will leverage risk adjustment data and associated insights to inform clinical programs and quality strategies for use in complex care management, high-risk programs, and other 5-Star program elements.
    • Data from this program will also inform care delivery strategies including community-based primary or supportive care, or other operating model considerations designed to improve access to care.


  • Data Submission and Reconciliation:

    • This role will be accountable for the accuracy, completeness, timeliness, and optimization of all data submissions to regulators, customers, and other key stakeholders, and will perform root cause and trend analysis to inform upstream operational processes to improve the delivery of such data.


  • Performance Management, Reporting, and Benchmarking:

    • This role will inform and develop a comprehensive and robust data analytics strategy and performance management reporting suite to ensure full transparency over risk adjustment reporting for all lines of business, inclusive of benchmarking against best practices and publicly available data.


  • Risk Adjustment Factor Forecasting:

    • In partnership with national finance, actuarial, and other leaders, support the accurate development of Enterprise, product level risk adjustment forecasting for financial, clinical, and other product development and actuarial modeling such as the Medicare Advantage annual bid process and the ACA rate filings, among others.


  • Product Development and Growth Strategy:

    • This role will partner with actuarial and product teams to leverage condition prevalence data and forecasts to improve the suite of products that Kaiser Permanente can deliver to current and prospective members and customers based on the current and expected prevalence and acuity of conditions and healthcare needs of the population.
    • This may include core benefits, supplemental benefits, clinical programs, an

  • Senior Vice President, National Risk Adjustment Strategy

    4 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Job Summary:The Senior Vice President, National Risk Adjustment Strategy will be responsible for developing and executing a comprehensive risk adjustment strategy to ensure the accuracy and completeness of clinical data submitted to regulators and customers. This role will require a deep understanding of the regulatory environment, clinical data integrity,...

  • Senior Vice President, National Risk Adjustment Strategy

    4 weeks ago

    Oakland, California, United States Kaiser Permanente Full time

    Job Summary:The Senior Vice President, National Risk Adjustment Strategy will be responsible for developing and executing a comprehensive risk adjustment strategy for Kaiser Permanente's National Health Plan. This role will require a deep understanding of the regulatory environment, risk adjustment models, and data analytics. The successful candidate will...

  • Vice President and Chief Risk Officer

    3 weeks ago

    Oakland, United States Kaiser Permanente Full time

    Job Summary: Reporting to the EVP, Enterprise Strategy and Business Development, the Vice President and Chief Risk Officer is responsible for driving integration of enterprise risk management (ERM) into strategic, financial, and operational processes. This role serve as a key leader in aligning risk management with KP’s enterprise strategic and business...

  • Risk Adjustment Consulting, Senior

    7 days ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    6 days ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    6 days ago

    Oakland, United States Blue Shield of California Full time

    Your RoleThe Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    5 days ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    7 days ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    7 days ago

    Oakland, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Vice President, Business Development

    3 weeks ago

    Oakland, United States Kaiser Permanente Full time

    Job Summary: The Vice President of Business Development will play a critical role in KP’s overall growth agenda. She/he will support the marketplace efforts working with the Senior Vice President, Chief Business Development Officer along with other members of the national leadership team. The VP pursues identification, valuation, due diligence, and...

  • Vice President, Business Development

    3 weeks ago

    Oakland, United States Kaiser Permanente Full time

    Job Summary: The Vice President of Business Development will play a critical role in KP’s overall growth agenda. She/he will support the marketplace efforts working with the Senior Vice President, Chief Business Development Officer along with other members of the national leadership team. The VP pursues identification, valuation, due diligence, and...

  • Risk Adjustment Consulting, Senior

    6 days ago

    Oakland, CA, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    6 days ago

    Oakland, CA, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    6 days ago

    Oakland, CA, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    17 hours ago

    Oakland, CA, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Risk Adjustment Consulting, Senior

    3 days ago

    Oakland, CA, United States Blue Shield of California Full time

    Your Role The Risk Adjustment Provider Partnership team provides essential support to all functions within the risk adjustment program, which includes interaction with various cross-functional teams within Blue Shield and contracted Provider Groups. The Risk Adjustment Consultant, Senior will report to the Manager, Risk Adjustment Provider Partnership. In...

  • Vice President, Medicaid

    4 weeks ago

    Oakland, United States Kaiser Permanente Full time

    Job Summary:The VP of Medicaid is a key leader of the Medicaid national line of business and responsible for leading, managing and/or coordinating KP’s Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships and related activities in multiple states. The position involves close...

  • Vice President, Medicaid

    2 weeks ago

    Oakland, United States Kaiser Permanente Full time

    Job Summary:The VP of Medicaid is a key leader of the Medicaid national line of business and responsible for leading, managing and/or coordinating KP’s Medicaid strategy, planning, regulatory relationships, health plan operations, member service, compliance, industry relationships and related activities in multiple states. The position involves close...

  • Vice President, Deputy Chief Compliance Officer

    3 weeks ago

    Oakland, United States Kaiser Permanente Full time

    Job Summary: The Deputy Chief Compliance Officer is responsible for assisting the Chief Compliance and Privacy Officer in managing an effective ethics and compliance program. This includes infrastructure development, policy management, training, monitoring/auditing, conducting and documenting investigations, addressing and resolving violations, errors, and...

  • Nurse Practitioner

    4 weeks ago

    Oakland, Maryland, United States Hueman Risk Adjustment Full time

    Job OpportunityHueman Risk Adjustment is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members. This unique opportunity offers flexibility and the freedom to achieve your professional goals on your terms.Key ResponsibilitiesTravel to and from patients' homes to perform comprehensive,...