Lead, Organic Risk Adjustment

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.

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.
• Ability to analyze data trends, identify opportunities, and translate insights into operational action plans.
• Strong communication, facilitation, and stakeholder management skills.

Preferred Qualifications

• Experience leading enterprise-wide transformation, performance improvement, or strategic business initiatives.
• Experience building new programs, operating models, capabilities, or processes from the ground up.
• Prior people leadership or matrixed team leadership experience.
• Demonstrated track record of challenging conventional approaches and developing innovative solutions to complex business problems.

Work Arrangements

• Remote position
• Occasional travel to Humana's offices for training or meetings may be required
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

• 40

Pay Range

• $115,200 - $158,400 per year

Benefits

• Medical, dental, and vision 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