CareMore Health, a Mosaic Health company
Medical Director, Risk Adjustment
CareMore Health, a Mosaic Health company, Las Vegas, Nevada, us, 89105
Morgan Consulting Resources, Inc. has been retained to conduct the search for a Medical Director, Risk Adjustment with CareMore Health. This is a remote position with some travel required to market and enterprise sites across Las Vegas, NV, Tucson, AZ, and Southern California.
About the Organization At CareMore Health, we provide effective Advanced Primary Care by seeing the whole person – body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy‑living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted. For more than 30 years, CareMore Health has delivered highly integrated, personalized care that has led the industry with exceptional clinical outcomes proven to lower the cost of care. We specialize in managing complex and chronically ill patients and providing life‑changing care wherever they are – in the home, virtually, in our Care Centers, mobile units, and at skilled nursing facilities. CareMore was an early advocate of value‑based care and has a successful history of full‑risk capitation, risk sharing and accountability for cost and outcomes.
With health plan experience, we understand the challenges of fully managing complex populations. We are agile and can flex to meet your needs in the following areas:
Complex Care – A team‑based care model that delivers integrated whole‑person care to address all aspects of the patient’s needs
Full Population Health – A whole‑health care model that coordinates care for Medicare and Medicaid populations, whether members are healthy, at risk, or in need of palliative care
Commercial – We specialize in managing complex and chronic patients, improving outcomes and reducing the cost of care.
Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi‑payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher‑need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value‑based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals’ health and wellbeing, while helping care providers deliver higher quality care.
About the Position Reporting to the Vice President, Risk Adjustment & Quality, the Medical Director, Risk Adjustment will serve as the clinical expert responsible for advancing CareMore Health’s risk adjustment strategy. This physician expert will guide providers in accurate and complete documentation of patient complexity and chronic conditions, ensuring compliance with CMS requirements while supporting enterprise revenue integrity.
The role will focus on healthcare provider education, data‑driven interventions, and cross‑functional collaboration with coding, analytics, and operations teams to maximize risk score accuracy, reduce audit exposure, and align risk adjustment with clinical and business objectives. The Medical Director will serve as a Subject Matter Expert and Individual Contributor for CareMore Health.
Key Responsibilities Clinical Risk Adjustment Leadership
Provide physician leadership in CareMore’s risk adjustment strategy, ensuring accurate capture of patient complexity and chronic conditions.
Partner with enterprise leaders to set goals and monitor performance outcomes tied to risk adjustment and revenue integrity.
Provider Engagement & Education
Design, develop, and deliver education programs for physicians, advanced practice providers, and clinical staff to improve documentation integrity and coding accuracy.
Serve as a visible champion for prospective risk capture at the point of care.
Act as a trusted advisor and subject matter expert for providers on HCC coding and documentation best practices.
Data Analysis & Performance Improvement
Review coding, documentation, and quality data to identify performance gaps at provider, clinic, and market levels.
Lead targeted interventions to improve RAF accuracy, reduce audit risk, and strengthen compliance.
Collaborate with analytics teams to develop dashboards and reporting tools that track progress.
Cross‑Functional Collaboration
Partner closely with coding, compliance, analytics, and operations teams to integrate risk adjustment into broader CareMore and Mosaic Health initiatives.
Ensure risk adjustment strategies support enterprise priorities in quality, value‑based care, and financial performance.
Compliance & Audit Readiness
Ensure all risk adjustment practices adhere to CMS and OIG regulations, including RADV requirements.
Maintain audit‑ready documentation and support compliance teams in responding to regulatory inquiries.
Proactively adapt strategies based on regulatory changes to protect revenue integrity and enterprise reputation.
Short‑term Goals Partner with Risk Adjustment business leaders to develop insightful and actionable reporting, partner with providers to identify the top three documentation and coding improvement opportunities, and launch targeted education that drives quick wins.
Long‑term Goals Build a sustainable, systemwide RA education program and clinical documentation infrastructure that continuously elevates provider performance and strengthens long‑term risk‑adjustment outcomes.
Minimum Qualifications
MD or DO required with active, unrestricted medical license.
Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.
8+ years of clinical practice experience, with at least 3–5 years in an expert‑level role involving risk adjustment, clinical documentation improvement (CDI), or value‑based care.
Demonstrated success leading provider education and engagement programs to improve coding and documentation.
Experience with Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits).
Knowledge & Skills
Strong clinical and regulatory expertise in risk adjustment models and documentation standards.
Data‑driven leader with proven ability to interpret coding and quality data and translate into actionable interventions.
Excellent communication and presentation skills, with ability to engage diverse provider audiences.
Effective collaborator and change agent, able to partner across clinical, operational, and business teams.
Compensation A reasonable base salary expectation is $240,000 to $300,000 and is based on experience, location, and internal equity. This position is eligible for an annual bonus up to $50,000.
Erica Eikelboom, Principal & Executive Search Consultant erica@morganconsulting.com
#J-18808-Ljbffr
About the Organization At CareMore Health, we provide effective Advanced Primary Care by seeing the whole person – body, mind, and spirit. We do it with doctors and nurses who provide personalized and compassionate care, nationally recognized disease prevention and management programs, and healthy‑living plans. It helps patients get healthier, while receiving the healthcare experience they’ve always wanted. For more than 30 years, CareMore Health has delivered highly integrated, personalized care that has led the industry with exceptional clinical outcomes proven to lower the cost of care. We specialize in managing complex and chronically ill patients and providing life‑changing care wherever they are – in the home, virtually, in our Care Centers, mobile units, and at skilled nursing facilities. CareMore was an early advocate of value‑based care and has a successful history of full‑risk capitation, risk sharing and accountability for cost and outcomes.
With health plan experience, we understand the challenges of fully managing complex populations. We are agile and can flex to meet your needs in the following areas:
Complex Care – A team‑based care model that delivers integrated whole‑person care to address all aspects of the patient’s needs
Full Population Health – A whole‑health care model that coordinates care for Medicare and Medicaid populations, whether members are healthy, at risk, or in need of palliative care
Commercial – We specialize in managing complex and chronic patients, improving outcomes and reducing the cost of care.
Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi‑payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher‑need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value‑based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals’ health and wellbeing, while helping care providers deliver higher quality care.
About the Position Reporting to the Vice President, Risk Adjustment & Quality, the Medical Director, Risk Adjustment will serve as the clinical expert responsible for advancing CareMore Health’s risk adjustment strategy. This physician expert will guide providers in accurate and complete documentation of patient complexity and chronic conditions, ensuring compliance with CMS requirements while supporting enterprise revenue integrity.
The role will focus on healthcare provider education, data‑driven interventions, and cross‑functional collaboration with coding, analytics, and operations teams to maximize risk score accuracy, reduce audit exposure, and align risk adjustment with clinical and business objectives. The Medical Director will serve as a Subject Matter Expert and Individual Contributor for CareMore Health.
Key Responsibilities Clinical Risk Adjustment Leadership
Provide physician leadership in CareMore’s risk adjustment strategy, ensuring accurate capture of patient complexity and chronic conditions.
Partner with enterprise leaders to set goals and monitor performance outcomes tied to risk adjustment and revenue integrity.
Provider Engagement & Education
Design, develop, and deliver education programs for physicians, advanced practice providers, and clinical staff to improve documentation integrity and coding accuracy.
Serve as a visible champion for prospective risk capture at the point of care.
Act as a trusted advisor and subject matter expert for providers on HCC coding and documentation best practices.
Data Analysis & Performance Improvement
Review coding, documentation, and quality data to identify performance gaps at provider, clinic, and market levels.
Lead targeted interventions to improve RAF accuracy, reduce audit risk, and strengthen compliance.
Collaborate with analytics teams to develop dashboards and reporting tools that track progress.
Cross‑Functional Collaboration
Partner closely with coding, compliance, analytics, and operations teams to integrate risk adjustment into broader CareMore and Mosaic Health initiatives.
Ensure risk adjustment strategies support enterprise priorities in quality, value‑based care, and financial performance.
Compliance & Audit Readiness
Ensure all risk adjustment practices adhere to CMS and OIG regulations, including RADV requirements.
Maintain audit‑ready documentation and support compliance teams in responding to regulatory inquiries.
Proactively adapt strategies based on regulatory changes to protect revenue integrity and enterprise reputation.
Short‑term Goals Partner with Risk Adjustment business leaders to develop insightful and actionable reporting, partner with providers to identify the top three documentation and coding improvement opportunities, and launch targeted education that drives quick wins.
Long‑term Goals Build a sustainable, systemwide RA education program and clinical documentation infrastructure that continuously elevates provider performance and strengthens long‑term risk‑adjustment outcomes.
Minimum Qualifications
MD or DO required with active, unrestricted medical license.
Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.
8+ years of clinical practice experience, with at least 3–5 years in an expert‑level role involving risk adjustment, clinical documentation improvement (CDI), or value‑based care.
Demonstrated success leading provider education and engagement programs to improve coding and documentation.
Experience with Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits).
Knowledge & Skills
Strong clinical and regulatory expertise in risk adjustment models and documentation standards.
Data‑driven leader with proven ability to interpret coding and quality data and translate into actionable interventions.
Excellent communication and presentation skills, with ability to engage diverse provider audiences.
Effective collaborator and change agent, able to partner across clinical, operational, and business teams.
Compensation A reasonable base salary expectation is $240,000 to $300,000 and is based on experience, location, and internal equity. This position is eligible for an annual bonus up to $50,000.
Erica Eikelboom, Principal & Executive Search Consultant erica@morganconsulting.com
#J-18808-Ljbffr