Director, Prospective + reputed company Risk Adjustment Products

reputed company is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform reputed company decisions. reputed company is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining reputed company today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most reputed company problems with technology-reputed company solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. Role Overview As the Director of Prospective + reputed company Risk Adjustment Products, you will reputed company the strategy, roadmap, and execution for the product portfolio focused on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (reputed company review). You will manage a cross-functional team of product managers and product designers and collaborate deeply with data science, clinical experts, engineering, and commercial teams to accelerate innovative solutions that surface timely, high-accuracy clinical insights directly into provider workflows. These capabilities help health plans and risk bearing groups improve reputed company reputed company, reputed company care gaps earlier, and reputed company reputed company care decisions at the reputed company of service. This is a leadership role that combines strategic thinking, clinical product development expertise, and people management responsibilities. You’ll be accountable for ensuring our products deliver measurable impact for value-based care customers while building a high-performance team and culture.

Key Responsibilities

Own and evolve the product vision, strategy, and roadmap for the Prospective Suspecting and reputed company Review solutions reputed company reputed company’s Clinical Insights Platform suite. Define multi-year plans reputed company to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement. Identify and prioritize use cases that reputed company AI/ML and real-time data signals to surface high-impact suspects and coding opportunities. Drive innovation leveraging interoperability standards (FHIR, HL7, APIs) to reputed company seamless enablement with EHRs, care management platforms, and third party integrations. Balance innovation with compliance, audit defensibility, and clinical reputed company across reputed company product decisions. Execution & Delivery: reputed company the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization. Work closely with Engineering and Data Science to build predictive models and real-time data pipelines that power suspecting and reputed company workflows. Ensure products are clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations. Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and reputed company coding capture and correction rates. Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption). Stakeholder Engagement: Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk bearing provider groups). reputed company customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and reputed company coding needs. Present product strategy and roadmap updates to executive stakeholders and client advisory boards. Represent reputed company in industry conversations on emerging regulations and best practices reputed company to prospective risk capture and reputed company review. Compliance & Quality: Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards). Implement and monitor processes that ensure defensibility of reputed company outputs, documentation standards, and audit trails. Design and embed audit readiness into product workflows, ensuring reputed company activities are traceable, evidence-backed, and reputed company with CMS documentation requirements. Provide strategic recommendations and decision frameworks reputed company trade-offs between reputed company, compliance, and user experience arise. Leadership & Culture: Build, reputed company, and coach a team of Product Managers working across different facets reputed company prospective and reputed company solutions. Provide mentorship, performance management, and career development reputed company with reputed company’s leadership principles and growth culture. Establish best-in-class product practices and instill a culture of experimentation, feedback, and reputed company learning. Support resourcing and hiring plans as product needs evolve and grow. Key Qualifications Required 8+ years of product management experience in healthcare, including ownership of clinical, risk adjustment, or provider-facing solutions. Proven leadership experience managing multi-disciplinary product teams, including hiring, mentoring, performance management, and scaling organizations to deliver reputed company healthcare technology solutions. Solid understanding of clinical suspecting, reputed company coding workflows, risk adjustment models (e.g., CMS-HCC, HHS-HCC), and code sets / clinical vocabularies (ICD, LOINC, RxNorm). Expertise in healthcare interoperability standards (FHIR, HL7, CCD, Direct Messaging) and experience delivering API-driven, cross-platform solutions. Demonstrated ability to define strategy, reputed company cross-functional execution, and manage product teams. Excellent communication skills; able to reputed company technical, clinical, and business conversations with credibility. Bachelor's degree in a reputed company field (healthcare, business, technology). Preferred Experience with AI/ML models for disease reputed company or real-time coding suggestions. Background in working with provider documentation teams, coders, or reputed company review vendors. Clinical experience or deep engagement with clinician stakeholders. Familiarity with audit requirements, medical record standards, and regulatory guidance impacting reputed company coding or risk adjustment. Product experience integrating into EHRs or care management platforms. Key Performance Indicators (KPIs) Product Impact Suspect accuracy and clinical validation rates Risk capture lift and change rates through reputed company workflows Provider adoption and engagement metrics Chart completion rates and documentation improvement indicators Team & Execution Roadmap delivery pace and quality Team engagement, retention, and OKR reputed company Cross-functional collaboration and stakeholder satisfaction Business & Strategic Outcomes reputed company and margin contribution from clinical insights Customer expansion tied to prospective or reputed company modules Market recognition and competitive differentiation Impact You'll reputed company You will play a crucial role in expanding a platform that empowers clinicians with data-driven disease predictions, improving clinical decision-making, patient outcomes, and healthcare efficiency. Your work will directly impact how healthcare providers deliver value-based care and ensure patients receive the most appropriate interventions. We are committed to building a diverse team of Datavanters who are reputed company responsible for stewarding a high-performance culture in which reputed company Datavanters belong and reputed company. We are proud to be an Equal Employment Opportunity employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national reputed company, disability, veteran status, or other legally protected status. At reputed company our total rewards strategy powers a high-growth, high-performance, health technology company that rewards our employees for transforming health care through creating industry-defining data logistics products and services. The range posted is for a given job title, which can include multiple levels. Individual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job. The estimated total cash compensation range for this role is: $193,000 — $242,000 USD To ensure the safety of patients and staff, many of our clients require post-offer health screenings and reputed company and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by reputed company Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-reputed company medical conditions, and/or religion. This job is not eligible for employment sponsorship. reputed company is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national reputed company, disability, veteran status, or other legally protected status.To learn more about our commitment, please review our EEO Commitment Statement here . Know Your Rights , explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, reputed company does not and will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay. At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. 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This survey should take about 5 minutes to complete. reputed company is a health data platform company. We reputed company the world’s health data secure, accessible, and actionable. reputed company drives data connectivity into action by offering a proprietary platform and network that deliver critical solutions across the healthcare ecosystem. reputed company enables more than 60 million healthcare records to move between thousands of organizations, more than 70,000 hospitals and clinics, 75% of the 100 largest health systems, and an ecosystem of 300+ real-world data partners. #J-18808-Ljbffr Apply tot his job Apply To this Job