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We are seeking a Lead, Organic Risk Adjustment to build, operationalize, and scale Humana's Organic Risk Adjustment (ORA) program.
This is not a role focused on maintaining existing processes or operating from the sidelines. We are looking for a builder and change agent who enjoys creating structure where it does not exist, solving complex business challenges, and turning ideas into measurable results. The ideal candidate is equally comfortable developing strategy, leading large-scale initiatives, influencing senior leaders, and driving day-to-day execution.
Success in this role requires the ability to navigate ambiguity, challenge traditional ways of working, and bring together diverse stakeholders to deliver meaningful outcomes. This individual will play a key role in shaping and evolving the Organic Risk Adjustment program while helping the organization rethink how risk adjustment opportunities are identified, prioritized, and embedded within routine provider workflows.
The role will partner closely with clinical, operational, analytical, and business leaders across the enterprise to improve program performance and build sustainable capabilities that drive long-term impact.
Key Responsibilities
Program Development & Execution
- Build and operationalize programs that improve Organic Risk Adjustment performance.
- Design and implement workflows, playbooks, provider engagement approaches, and reporting processes from the ground up.
- Identify opportunities, develop action plans, and drive execution through completion.
- Manage multiple initiatives simultaneously while ensuring measurable business outcomes.
- Serve as the point person for day-to-day execution of key Organic Risk Adjustment initiatives.
- Create structure, processes, and operating models in areas where established solutions do not yet exist.
- Translate strategic priorities into executable work plans and deliverables.
Enterprise Leadership & Transformation
- Lead complex, cross-functional initiatives involving clinical, operational, analytical, and business partners.
- Partner with senior leaders to identify opportunities, align priorities, and remove barriers to execution.
- Challenge existing processes and traditional approaches to create more effective, scalable, and sustainable solutions.
- Influence decisions and drive action across stakeholders without direct authority.
- Help shape the future direction and operating model of Organic Risk Adjustment as the program evolves.
- Foster a culture of innovation, continuous improvement, and accountability.
Provider & Operational Partnership
- Partner with providers, practice leaders, operations teams, and clinical stakeholders to improve performance and outcomes.
- Develop practical solutions that fit within existing provider and operational workflows.
- Facilitate meetings, maintain alignment, and ensure follow through on commitments and action plans.
- Build strong working relationships across a diverse set of stakeholders and business partners.
Analytics & Performance Improvement
- Analyze data to identify performance improvement opportunities and operational insights.
- Translate findings into actionable recommendations and implementation plans.
- Monitor program outcomes and adjust strategies based on results.
- Develop reporting approaches that support decision-making, accountability, and continuous improvement.
Required Qualifications
- Demonstrated success leading large-scale, cross-functional initiatives from concept through implementation.
- Experience in Medicare Advantage, value-based care, population health, healthcare operations, quality improvement, risk adjustment, or related healthcare performance programs.
- Experience partnering with senior leaders to drive organizational change and operational improvement.
- Proven ability to influence stakeholders across clinical, operational, analytical, and business teams.
- Strong problem-solving skills with the ability to navigate ambiguity and create structure in evolving environments.
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Lead, Organic Risk Adjustment in Dover employer: Humana
Humana Inc. is an exceptional employer that prioritises employee development and offers a supportive work culture, making it an ideal place for those passionate about healthcare education. With opportunities for professional growth and a focus on collaboration, employees can thrive while contributing to meaningful improvements in provider documentation and patient care. The remote nature of this role allows for flexibility, ensuring a healthy work-life balance while engaging with a diverse team dedicated to excellence.
