173 Bridge Plaza North
Fort Lee, NJ 07024
Innovacare Health operates a growing family of integrated
healthcare companies focused on improving the health of patient
populations through value-based, coordinated care. Through
physician-led models and cutting-edge technology, InnovaCare has
built a 20-year track record of growth and a national reputation
for excellence. In each unique market the company enters,
InnovaCare works across the healthcare ecosystem – with patients,
providers, payers and other partners – to increase access to
high-quality, coordinated care.
Based in White Plains, N.Y., InnovaCare manages nearly 600,000
lives, including one of the highest percentages of dual-eligible
beneficiaries in the nation. Since 1998, InnovaCare and its
subsidiaries have been market leaders in transforming healthcare by
distributing risk and developing proprietary technologies to
inspire patient and provider engagement. The company’s physician
practices and health plans have continuously received some of the
nation’s highest scores for quality from the Centers for Medicare
and Medicaid Services (CMS).
With strong financial support from a leading global investment
firm, Summit Partners, InnovaCare combines management expertise,
value-based solutions, best-in-class technology and data analytics
to achieve industry-leading outcomes and deliver the best possible
experience to members and patients.
Summit Partners is a global alternative investment firm that
currently manages more than $19 billion in capital dedicated to
growth equity, fixed income and public equity opportunities. Summit
invests across growth sectors of the economy and has invested in
more than 500 companies in technology, healthcare, consumer,
financial and business services, and other growth industries.
Summit maintains offices in North America and Europe, and invests
in companies around the world.
InnovaCare is seeking a very qualified VP of Risk Adjustment
with extensive leadership experience in the area of managed care /
health plan setting. This remote position entails about 50% travel
to Florida and Puerto Rico offices.
Position Summary :
VP of Risk Adjustment
Job Description : The Vice President of Risk Adjustment is
responsible for the oversight of risk adjustment and coding within
the organization and plays a critical role in the development and
execution of business strategy and compliance of a growing
healthcare enterprise that is currently the 9th largest Medicare
Advantage plan in the country.
Oversees the development, implementation and execution of
compliant of Medicare advantage and Managed Medicaid risk
adjustment strategy utilizing CMS HCC and CDPS models,
respectively. This leadership role interacts as a key business
partner to the Chief Medical Officer, Market Leaders, product
design, and strategic planning.
Role Specific Competencies:
Managing Vision and Purpose
Driving for Results
A Master’s degree in Business Administration, Public Health or
Healthcare Administration preferred.
Strong business fundamentals and prior experience in Health
Services are a requirement. Individual will have proven leadership
capabilities, executive presence, outstanding communication skills
and be proficient at driving change.
Professional Experience and Knowledge
7 years leadership experience at a senior level, preferably with
a large organization and multi-site locations.
Experience in a complex healthcare delivery environment,
including risk assessment and revenue optimization.
Significant experience setting strategy for Risk Assessment,
Medical Coding, and designing models for effective improvement of
proper documentation and coding of clinical diagnoses.
Possess a proven track record of leading high performing teams
and developing new product/service offerings.
Excellent leadership skills including ability to think
strategically, develop vision, and execute for results.
Proven ability to innovate and drive large organization
Experience working in a large highly matrixed organization, with
proven ability to develop internal enterprise relations, and
Excellent presentation and communication skills.
Strong business and financial background with a sense of urgency
and a desire to achieve top line results in a fully appropriate and
Demonstrated experience in risk assessment and revenue
optimization achieved through informatics and analytic data.
Skills • Strong knowledge of Medicare and Medicaid Risk
Adjustment, including technical requirements as well as challenges
health plans and providers may have in meeting reporting
requirements • Understanding of applicable CMS Medicare Part C & D
reporting requirements including manuals, review guides and Code of
Federal Regulations • Ability to interact with internal and
external customers at all management levels • Project management
and/or consulting experience a plus • Strong problem solving
ability and a customer centric focus • Be team focused with an
attitude of group achievement as the primary goal • Highly
organized with a strong attention to detail • Demonstrated
leadership and management skills • Effective collaboration skills
and experience • MS Office proficiency • Strong oral and written
communication skills, including presentation skills • Ability to
work in a virtual office and virtual teaming experience
Duties & Responsibilities • Responsible for project planning,
management and execution of key initiatives and projects •
Responsible for the development of new scopes of work and
refinement of existing scopes of work to assure they meet company’s
current needs • Provides guidance and information, when requested,
as an internal resource • Provide industry guidance to staff within
the Risk Adjustment and Coding Department • Ensure skill sets of
staff are up-to-date and at the highest level of industry
Serves as the strategic leader accountable for utilizing
analytics coupled with clinical technology to maximize growth and
drive continuous improvement in appropriate documentation and
Oversees physician education and engagement strategy and
execution for risk adjustment; and national and market-based
coding, and related vendor relationships.
Drives technological advancement; Oversees the development and
execution of risk adjustment programs that ensure timely and
accurate assessment and reporting of chronic conditions.
Ensures that staff collaborates with medical leadership, market
leaders, and utilization management leaders to stay current with