Dir. Medicare and Risk Adjustment Strategic Initiatives

Dir. Medicare and Risk Adjustment Strategic Initiatives

Work a Hybrid schedule within Oregon, Washington, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s dedicated team of Dir. Medicare and Risk Adjustment Strategic Initiatives is living our mission to make health care easier and lives better. As a member of the Government Programs team, our The Director Medicare and Risk Adjustment Strategic Initiatives partners with the leadership team to optimize strategic governance, planning and execution in support of day-to-day priorities within the strategic plan. Leads strategic projects, provides relevant data insights and reporting, prepares executive communications, facilitates leadership meetings and agendas, and oversees annual planning processes. And provides counsel to senior management and directs cross-functional teams to influence change. In Medicare Risk Adjustment the role provides strategic leadership to develop internal talent and address critical operational gaps. Works alongside the Risk Adjustment leader to transform approach into a proactive, well-organized operation that maximizes team potential while delivering measurable business results – all in service of creating a person-focused health care experience.  

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications:

The Director Medicare and Risk Adjustment Strategic Initiatives would have a BA/BS in business management, healthcare administration, finance or relevant field, MBA or MHA preferred, and at least 10 years of executive business strategy, planning, and performance management experience. Or equivalent combination of education and experience.

Manages up to 10 FTEs (temporary and permanent) in addition to managing projects with consulting firms.

 Skills and Attributes: 

• Provides leadership to Acceleration Office functions by directing the performance management model for business strategies and coaching delivery leaders to achieve execution success, in partnership with the Acceleration Office Lead.

• Navigates the matrix, influencing without direct authority, and fosters a collaborative work environment to drive impact.

• Manages division rhythm of the business (ROB), business operating reviews, and executive reporting.

• Directs performance improvement in managing vendors as appropriate.

• Manages cross-cutting initiatives and enablers to deliver value (e.g. in-home assessments).

• Manages special projects and participates in enterprise committees and workgroups as needed.

• Advises and supports the SVP Government Programs with running the division, leadership engagement, and external engagement.

• Represents the division on behalf of the SVP Government Programs as assigned and provides input to corporate objectives and business decisions based on impact to Medicare programs.

• Proactively address business issues and collaborate with team members to solve problems quickly and thoughtfully.

• Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise.

• Demonstrates and fosters an ability to work effectively with existing leadership and generate positive team responses.

• Demonstrates a strong understanding of operational analytics to work with analytics teams.

• Provides a calm, strategic mindset during challenging situations.

• Demonstrated ability to leverage AI tools and resources to drive efficiency and innovation within area of expertise

What You Will Do at Cambia:  

• Leads development of multi-year strategies, roadmaps, KPIs for targeted business functions (Risk adjustment is focus for 2026).

• Facilitates and supports annual business planning activities for the division in partnership with Actuary and Strategic Finance leaders.

• Defines targets and priorities to improve county MLRs, member MLRs, and provider performance for Medicare Advantage.

• Provides decision support expertise to senior leadership team on strategic and operational matters.

Medicare Risk Adjustment Responsibilities:

• Develop talent, strengthen capability, and develop future Risk Adjustment leadership.

• Lead/support development and execution of long-term organizational goals.

• Focus on overall success and long-term organizational goals rather than just tactical execution.

• Thought leadership to boost performance and effectiveness of underperforming RA campaigns.

• Ability to establish end-to-end accountability for critical processes like MRA, EMR records management, QIP, CDI, and IHA programs, as some programs currently lack dedicated ownership.

• Experience building sustainable infrastructure and improving operational efficiency for the RA team that lacks proper organization.

• Strategic oversight of vendor relationships and chart retrieval operations with significant improvement opportunities.

• Capability to strengthen QIP, CDI, IHA, and provider education programs.

Work Environment

• Must be able to travel to all company service areas and locations, as well as to outside conferences and business meetings.

• Must be able, on occasion, to represent the company to outside organizations, or speak publicly on behalf of the company.

The expected hiring range for a Dir Medicare and Risk Adjustment Strategic Initiatives is $215,100.00 - $290,950.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 25%.  The current full salary range for this role is $202,000.00 to $329,000.00.

#LI-hybrid

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. 
• Annual employer contribution to a health savings account.  
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. 
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). 
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). 
• Award-winning wellness programs that reward you for participation. 
• Employee Assistance Fund for those in need. 
• Commute and parking benefits. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.