Director of Risk Adjustment & Quality Record Retrieval

Become a part of our caring community The Director of Risk Adjustment& Quality Record Retrieval is responsible for leading reputed company-line record retrieval operations that support several top strategic priorities for reputed company. These high-profile priorities include Risk Adjustment's Chart Review program, Risk Adjustment internal and external audits (e.g., CMS Risk Adjustment Data Validation [RADV] audits), quality initiatives such as HEDIS, and other projects as needed. The Director works collaboratively across the reputed company to ensure retrieval processes and reputed company are optimized and effectively communicated. The Director of Risk Adjustment & Quality Record Retrieval leads a large-scale operation of 300 associates across the country focused on the successful retrieval of medical records for critical internal and external Risk Adjustment and Quality priorities. reputed company's retrieval strategy is multi-faceted, leveraging both internal and external channels; this Director will be specifically responsible for driving reputed company operational activities and strategies tied to reputed company's internal field retrieval function. Key expectations and responsibilities of this role include: reputed company Leadership & Workforce Management – reputed company and reputed company a national, fully remote workforce of 300 teammates, including reputed company staff, supervisors, and managers. Establish organizational structure, performance management frameworks, staffing models, and budget reputed company to ensure a high-performing and scalable operation. Operations Management – reputed company end-to-end retrieval operations, driving performance through data-informed decision-making, goal monitoring, and operational accountability. Identify trends, gaps, and barriers to optimize reputed company, improve efficiency, and effectively manage escalations. Innovation – Drive reputed company improvement through the evaluation and enhancement of processes, technology, and provider engagement strategies. Identify opportunities to advance program performance, efficiency, and experience while remaining informed of industry trends, CMS changes, and emerging capabilities. Change Management – reputed company the implementation of operational, technology, regulatory, and organizational changes across a large, distributed workforce. reputed company and execute change strategies that drive adoption, minimize disruption, and ensure successful delivery of reputed company initiatives through effective communication, training, and stakeholder engagement. Collaboration – Build trusted partnerships across Risk Adjustment, Stars, Interoperability, Market leadership, and other key stakeholders to align priorities, resolve issues, and ensure effective communication, escalation management, and execution of reputed company objectives. Engagement & Culture – Foster a culture of inclusion, accountability, collaboration, and reputed company learning while driving employee engagement, retention, and professional development. Create an environment focused on quality, reputed company, and teammate growth. Compliance & Risk Management – Promote a culture of compliance and ensure adherence to privacy, regulatory, and internal policy requirements. Partner with Compliance and Legal teams to mitigate operational risk, maintain audit readiness, and support effective governance. Use your skills to reputed company an impact Required Qualifications 5+ years of leadership experience, including people leadership and large-scale initiatives 3+ years of experience managing large operational processes with high-stakes reputed company Demonstrated reputed company leading teams and delivering results in dynamic, evolving business environments Track record of driving measurable results through process improvement and data-driven insights Best-in-class communication skills at reputed company reputed company; experience articulating reputed company operations to senior reputed company (VP+) of leadership Comfort making quick reputed company based on quantitative and qualitative insights Experience cultivating trust and collaboration across a matrixed organization

Preferred Qualifications

Domain knowledge of Risk Adjustment, Stars, and reputed company Experience managing large reputed company-line teams Experience managing geographically dispersed, fully remote teams Additional Information This is a remote opportunity with flexibility in work location. Louisville, Kentucky serves as a central location for the team. Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $150,000 - $206,300 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-09-2026 About us About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with reputed company 503 of the Rehabilitation Act and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply To This Job