Imperial Health Plan of California, Inc.
Senior Quality and Risk Adjustment Manager
Imperial Health Plan of California, Inc., Pasadena, California, United States, 91104
1 day ago Be among the first 25 applicants
Is your CV ready If so, and you are confident this is the role for you, make sure to apply asap. Imperial Health Plan of California, Inc. provided pay range This range is provided by Imperial Health Plan of California, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $125,000.00/yr - $135,000.00/yr Direct message the job poster from Imperial Health Plan of California, Inc. Risk Adjustment Manager is responsible for leading and optimizing risk adjustment operations across all lines of business and entities, including Medicare Advantage, Marketplace, and other affiliated health plans, medical groups, and MSO functions. This role serves as a subject matter expert on federal risk adjustment regulations, policies, and methodologies. The position involves close collaboration with internal teams, providers, and external partners to improve risk score accuracy, provider engagement, and regulatory compliance. The Sr. Manager will also lead the development and operationalization of reporting tools, analytics, and workflows to support risk adjustment performance and data integrity across programs. This role plays a key part in aligning cross-functional teams, driving RADV audit readiness, and informing enterprise-level decisions related to financial forecasting, coding accuracy, and population health. ESSENTIAL JOB FUNCTIONS: Lead Risk Adjustment Strategy & Operations:
Oversee the development, implementation, and continuous improvement of risk adjustment programs across all lines of business, including Medicare Advantage (CMS-HCC), Marketplace (HHS-HCC), and RxHCC models, ensuring regulatory compliance, coding accuracy, and risk score optimization. Stay Current on Model Versions & Methodologies:
Maintain deep expertise in CMS-HCC model updates (e.g., V24 vs. V28), RxHCC methodology for Medicare Part D, and HHS-HCC annual model recalibrations, including normalization factors, coding intensity adjustments, and future model transitions as released in CMS Advance Notices and Final Rate Announcements. Manage Department Staff & Cross-Functional Teams:
Provide strategic direction and oversight for Risk Adjustment and coding department staff. Assemble and lead cross-functional and ad hoc teams for specific initiatives such as RADV audit readiness, encounter accuracy improvement, and provider education. Build and Manage Risk Adjustment Reporting & BI Tools : Design, implement, and maintain dashboards and reporting tools to monitor performance metrics such as risk score trends, gap closure rates, encounter completeness, RxHCC attribution, and audit readiness benchmarks. Conduct Data Gap Analysis & Targeted Program Design:
Perform thorough analyses to identify documentation, coding, and encounter data gaps. Use findings to develop targeted retrospective and prospective strategies to improve risk capture and data completeness, especially in hard-to-reach or low-utilization populations. Provider and Vendor Collaboration:
Partner with provider groups, ACOs, MSOs, and vendors to ensure alignment with risk adjustment documentation and coding guidelines. Design and monitor clinical documentation improvement (CDI) initiatives to capture accurate and complete conditions, including RxHCC-relevant conditions. Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionPublic Relations, Analyst, and Health Care Provider IndustriesInsurance Referrals increase your chances of interviewing at Imperial Health Plan of California, Inc. by 2x Inferred from the description for this job Medical insurance Vision insurance 401(k) Get notified when a new job is posted. Sign in to set job alerts for “Risk Manager” roles. Los Angeles, CA $143,000.00-$188,000.00 2 weeks ago Los Angeles, CA $91,200.00-$160,444.00 3 weeks ago Senior Manager, Risk Operations - Payments and FraudChief Risk Officer / Legal Affairs / Full-time / Days Torrance, CA $160,000.00-$180,000.00 1 month ago Los Angeles Metropolitan Area $100,000.00-$120,000.00 3 weeks ago Director of Performance Improvement and Risk ManagerMANAGER, RISK MANAGEMENT (WORKERS' COMPENSATION)Director, Risk Management & Patient Safety - 6415 Los Angeles, CA $74.54-$93.55 17 hours ago West Hollywood, CA $180,000.00-$200,000.00 1 day ago San Marino, CA $120,000.00-$175,000.00 2 weeks ago Rosemead, CA $72,500.00-$101,500.00 1 week ago Los Angeles Metropolitan Area $150,000.00-$200,000.00 3 weeks ago Director of Risk Management/Patient Safety OfficerRisks and Controls Manager, Kuiper Financial Risks and Controls Culver City, CA $109,000.00-$185,000.00 1 week ago Operational Risk Business Oversight Manager ILogistics Protection & Security Risk Manager Los Angeles, CA $93,800.00-$172,000.00 10 hours ago Payments Risk Advisory and Oversight Manager We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Is your CV ready If so, and you are confident this is the role for you, make sure to apply asap. Imperial Health Plan of California, Inc. provided pay range This range is provided by Imperial Health Plan of California, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $125,000.00/yr - $135,000.00/yr Direct message the job poster from Imperial Health Plan of California, Inc. Risk Adjustment Manager is responsible for leading and optimizing risk adjustment operations across all lines of business and entities, including Medicare Advantage, Marketplace, and other affiliated health plans, medical groups, and MSO functions. This role serves as a subject matter expert on federal risk adjustment regulations, policies, and methodologies. The position involves close collaboration with internal teams, providers, and external partners to improve risk score accuracy, provider engagement, and regulatory compliance. The Sr. Manager will also lead the development and operationalization of reporting tools, analytics, and workflows to support risk adjustment performance and data integrity across programs. This role plays a key part in aligning cross-functional teams, driving RADV audit readiness, and informing enterprise-level decisions related to financial forecasting, coding accuracy, and population health. ESSENTIAL JOB FUNCTIONS: Lead Risk Adjustment Strategy & Operations:
Oversee the development, implementation, and continuous improvement of risk adjustment programs across all lines of business, including Medicare Advantage (CMS-HCC), Marketplace (HHS-HCC), and RxHCC models, ensuring regulatory compliance, coding accuracy, and risk score optimization. Stay Current on Model Versions & Methodologies:
Maintain deep expertise in CMS-HCC model updates (e.g., V24 vs. V28), RxHCC methodology for Medicare Part D, and HHS-HCC annual model recalibrations, including normalization factors, coding intensity adjustments, and future model transitions as released in CMS Advance Notices and Final Rate Announcements. Manage Department Staff & Cross-Functional Teams:
Provide strategic direction and oversight for Risk Adjustment and coding department staff. Assemble and lead cross-functional and ad hoc teams for specific initiatives such as RADV audit readiness, encounter accuracy improvement, and provider education. Build and Manage Risk Adjustment Reporting & BI Tools : Design, implement, and maintain dashboards and reporting tools to monitor performance metrics such as risk score trends, gap closure rates, encounter completeness, RxHCC attribution, and audit readiness benchmarks. Conduct Data Gap Analysis & Targeted Program Design:
Perform thorough analyses to identify documentation, coding, and encounter data gaps. Use findings to develop targeted retrospective and prospective strategies to improve risk capture and data completeness, especially in hard-to-reach or low-utilization populations. Provider and Vendor Collaboration:
Partner with provider groups, ACOs, MSOs, and vendors to ensure alignment with risk adjustment documentation and coding guidelines. Design and monitor clinical documentation improvement (CDI) initiatives to capture accurate and complete conditions, including RxHCC-relevant conditions. Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionPublic Relations, Analyst, and Health Care Provider IndustriesInsurance Referrals increase your chances of interviewing at Imperial Health Plan of California, Inc. by 2x Inferred from the description for this job Medical insurance Vision insurance 401(k) Get notified when a new job is posted. Sign in to set job alerts for “Risk Manager” roles. Los Angeles, CA $143,000.00-$188,000.00 2 weeks ago Los Angeles, CA $91,200.00-$160,444.00 3 weeks ago Senior Manager, Risk Operations - Payments and FraudChief Risk Officer / Legal Affairs / Full-time / Days Torrance, CA $160,000.00-$180,000.00 1 month ago Los Angeles Metropolitan Area $100,000.00-$120,000.00 3 weeks ago Director of Performance Improvement and Risk ManagerMANAGER, RISK MANAGEMENT (WORKERS' COMPENSATION)Director, Risk Management & Patient Safety - 6415 Los Angeles, CA $74.54-$93.55 17 hours ago West Hollywood, CA $180,000.00-$200,000.00 1 day ago San Marino, CA $120,000.00-$175,000.00 2 weeks ago Rosemead, CA $72,500.00-$101,500.00 1 week ago Los Angeles Metropolitan Area $150,000.00-$200,000.00 3 weeks ago Director of Risk Management/Patient Safety OfficerRisks and Controls Manager, Kuiper Financial Risks and Controls Culver City, CA $109,000.00-$185,000.00 1 week ago Operational Risk Business Oversight Manager ILogistics Protection & Security Risk Manager Los Angeles, CA $93,800.00-$172,000.00 10 hours ago Payments Risk Advisory and Oversight Manager We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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