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VP Clinical Risk Adjustment

Req #:  126469
Facility:  Advocate Physician Partners
Department:  Management/Supervisory
City:  Rolling Meadows
Posting Budget Status:  Day
Shift Type:  Full Time - Permanent
Posting FTE:  1

Position Requirements:

  • Bachelor's Degree required. Masters or above is preferred.
  • Associated business experience in the health care industry, preferably at a provider organization proficient in assuming financial risk.
  • Experience building and leading large teams
  • Understanding of the three primary risk adjusted business models
  • Medicare ACO (MSSP)
  • Medicare Advantage
  • ACA/Commercial
  • In-depth knowledge of CMS HCC risk adjustment model required.
  • Ability to acquire similar knowledge of the HHS model also required.
  • Ability to demonstrate leadership in a large healthcare system with complex reporting structures.
  • Strong presentation skills and relationship building skills with clinical/non-clinical personnel.
  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels.
  • Frequent travel.
  • May be required to attend early morning or evening meetings.

The VP of Clinical Risk Adjustment (CRA) will be responsible for developing AAH's enterprise CRA program using building blocks derived from capabilities existing at our three legacy organizations. This leader will be accountable for both the enterprise strategies and operational programs required for AAH to succeed in its spectrum of risk adjusted lines of business. Working across the three legacy organizations this leader will be responsible for developing an operational structure capable of improving performance across AAH's complex footprint.


  1. Develop and oversee a Risk Adjustment Business Operations team.
  2. Responsible for reimbursement and data submission cycles for various lines of business.
  3. Maintains up to date knowledge of current regulations, policies and statutes.
  4. Manages relationships with payers and other external entities pertaining to risk adjustment.
  5. Works with Managed Care and Business Development teams to develop contracts that must account for risk adjusted performance.
  6. Collaborates with the Clinical Operations Director, operationalizing outreach and other interventions designed to optimize risk adjustment performance.
  7. Collaborates with the Clinical Operations Director, and serves with HIT and Analytics teams.
  8. Develop and oversee a Clinical Operations team. Develops an overall education program for both newly hired and existing providers. Conducts a variety of in~person and virtual educational presentations. Curates a set of online educational resources.

Nearest Major Market: Chicago