Medical Director – Risk Adjustment (MD/DO)
Location: Los Angeles, CA
Job Type: Direct
Company: Optigy
Salary: $200k-$280k + Bonus
Category: Family Practice
Job Description Apply Now
Medical Director – Risk Adjustment (MD/DO)
We are actively seeking an experienced Medical Director – Risk Adjustment (MD/DO) for a full-time hybrid opportunity. In this pivotal leadership position, you will drive the clinical risk adjustment strategy for our organization, ensuring accurate documentation of patient complexity and chronic conditions. Your expertise will help maintain compliance with all Centers for Medicare & Medicaid Services (CMS) requirements while supporting revenue integrity and the advancement of value-based care initiatives.
The Medical Director – Risk Adjustment (MD/DO) role is essential for healthcare organizations focused on optimizing risk adjustment processes and delivering high-quality patient outcomes. This position offers the opportunity to lead cross-functional teams, collaborate with senior leadership, and directly impact performance improvement in a mission-driven environment. If you have a passion for clinical excellence, data-driven decision-making, and educating providers on best practices, this is an exciting opportunity to make a meaningful difference.
Our organization is committed to fostering a collaborative, innovative culture, and we value professionals who are adept at building relationships across clinical and administrative teams. As a Medical Director – Risk Adjustment (MD/DO), you will serve as a subject matter expert on Hierarchical Condition Category (HCC) coding, support audit readiness efforts, and help shape strategic decision-making through analytics and performance tracking tools.
Being located in Los Angeles, CA, provides access to a vibrant healthcare community and the benefit of working in a region known for its diverse patient populations and commitment to quality care. The hybrid employment model allows for flexibility in both onsite and remote work environments, supporting work-life balance and professional growth.
We encourage qualified candidates to apply for the Medical Director – Risk Adjustment (MD/DO) role and join our team in advancing healthcare outcomes. Click the application button to take the next step in your career journey.
Medical Director – Risk Adjustment (MD/DO) Summary- Lead the clinical development and execution of risk adjustment strategy for an innovative healthcare organization.
- Drive accurate documentation, coding, and capture of patient complexity in alignment with CMS and Medicare Advantage requirements.
- Collaborate with senior leadership, analytics, compliance, and clinical teams to optimize revenue integrity and audit readiness.
- Champion provider engagement and education to support organization-wide adoption of risk adjustment best practices.
- Provide expert physician leadership in risk adjustment and documentation integrity.
- Collaborate with executive and clinical teams to set strategic goals and monitor key outcomes.
- Develop and deliver ongoing education programs for physicians, advanced practice providers (APPs), and clinical staff focused on documentation and coding accuracy.
- Act as a trusted advisor and subject matter expert on HCC coding, RAF scoring, and risk adjustment best practices.
- Champion prospective risk capture at the point of care through provider engagement and mentoring.
- Review clinical documentation, coding, and quality data to identify opportunities for performance improvement at provider and market levels.
- Lead targeted interventions that enhance risk adjustment factor (RAF) accuracy, reduce audit risk, and improve compliance with all relevant regulations.
- Partner with analytics teams to develop dashboards and performance tracking tools for continuous improvement.
- Work cross-functionally with coding, compliance, operations, and analytics teams to align risk adjustment with broader organizational goals.
- Ensure audit readiness and maintain compliance with CMS, Office of Inspector General (OIG), and RADV audit requirements.
- Proactively adapt to regulatory changes to safeguard organizational revenue integrity.
- Competitive compensation and performance-based bonus structure.
- Hybrid work flexibility supporting onsite and remote collaboration.
- Comprehensive health and wellness benefits package.
- Mission-driven organization with a focus on value-based care and clinical outcomes.
- Collaborative work environment encouraging innovation and professional growth.
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree with an active, unrestricted medical license (required).
- Board certification in Internal Medicine, Family Medicine, or a related specialty (preferred).
- Minimum 8 years of clinical practice experience, with at least 3–5 years focused on risk adjustment, clinical documentation improvement (CDI), or value-based care.
- Demonstrated success leading provider education and engagement programs.
- Strong knowledge of Medicare Advantage and CMS risk adjustment methodologies, including HCC coding, RAF scoring, and RADV audits.
- Experienced physician leader skilled at translating complex risk adjustment concepts into actionable strategies for provider teams.
- Exceptional communicator, able to engage, educate, and motivate clinical and administrative stakeholders.
- Detail-oriented with a strong analytical mindset for reviewing data and driving performance improvement.
- Passionate about improving healthcare outcomes through value-based care and compliance excellence.
- Adaptable, proactive, and collaborative in a fast-paced, multidisciplinary environment.
- Opportunity to impact organizational strategy and patient outcomes at a system-wide level.
- Hybrid model supports flexible work arrangements within the Los Angeles, CA area.
- Organization supports ongoing professional development and leadership growth.
- Commitment to diversity, equity, and inclusion in all hiring and employment practices.
- Apply now to join our mission-driven team and shape the future of risk adjustment in healthcare.
Equal Opportunity Employer: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.