CareMore Health System
Medical Director - Risk Adjustment
CareMore Health System, Cerritos, California, United States, 90703
Medical Director - Risk Adjustment page is loaded## Medical Director - Risk Adjustmentlocations:
Cerritos, CA:
Nevada, USA:
Arizona, USAtime type:
Full timeposted on:
Posted 3 Days Agojob requisition id:
M101534**Job Description Summary**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.**How will you make an impact & Requirements**# **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.# **Qualifications:****Education & Licensure*** MD or DO required, with active, unrestricted medical license.* Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.**Experience*** 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.**Reporting & Structure*** **Reports to:** Vice President, Risk Adjustment & Quality (CareMore Health)* **Location:** Central to CareMore market and enterprise sites. (Southern California, Clark and Pima counties, AZ); requires 75% travel to market and enterprise sites.**\*\*The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.\*\*****Compensation:**toAt CareMore Health, we provide effective Advanced Primary Care and Palliative 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.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. For more information, please visit www.mosaichealth.com.Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@mosaichealth.com for assistance. #J-18808-Ljbffr
Cerritos, CA:
Nevada, USA:
Arizona, USAtime type:
Full timeposted on:
Posted 3 Days Agojob requisition id:
M101534**Job Description Summary**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.**How will you make an impact & Requirements**# **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.# **Qualifications:****Education & Licensure*** MD or DO required, with active, unrestricted medical license.* Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.**Experience*** 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.**Reporting & Structure*** **Reports to:** Vice President, Risk Adjustment & Quality (CareMore Health)* **Location:** Central to CareMore market and enterprise sites. (Southern California, Clark and Pima counties, AZ); requires 75% travel to market and enterprise sites.**\*\*The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.\*\*****Compensation:**toAt CareMore Health, we provide effective Advanced Primary Care and Palliative 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.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. For more information, please visit www.mosaichealth.com.Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@mosaichealth.com for assistance. #J-18808-Ljbffr