Director, Risk Adjustment Product & Technology

Job Description Summary

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The Director, Risk Adjustment Product & Technology will lead the product roadmap, and technology capabilities that enable Mosaic Health to identify, prioritize, orchestrate, and capture burden-of-illness opportunities across its patient populations.

This role will own the evolution of Mosaic’s enterprise Burden of Illness (BOI) Hub—the centralized intelligence and orchestration layer that brings together clinical, claims, payer, attribution, and supplemental data to determine which patients and clinical opportunities should be acted upon, through which intervention, and at what point in the workflow.

The Director will move the organization from fragmented, vendor-specific, and manually driven prioritization toward an enterprise-owned approach to risk adjustment decisioning and orchestration. The role will oversee how opportunities are identified, deduplicated, economically prioritized, routed to the appropriate execution engine, and measured through completion.

Sitting within Clinical Technology, this leader will partner closely with Risk Adjustment, Clinical, Coding, Operations, Product, Engineering, Data & Analytics, Finance, and market leadership.

The Director will also serve as a senior product and technology partner to external vendors, ensuring that platforms such as Navina operate as execution engines within Mosaic’s broader enterprise strategy rather than independently defining prioritization and workflow

The successful candidate will combine expertise in risk adjustment, healthcare product management, clinical technology, data, workflow design, and value-based care economics.

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How will you make an impact & Requirements

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Strategic Leadership

• Own the product vision, strategy, roadmap, and operating model for Mosaic’s enterprise risk adjustment technology capabilities.
• Lead development and maturation of the Burden of Illness Hub as the central orchestration capability for risk adjustment and related clinical opportunities.

• Translate Risk Adjustment, Clinical, Operations, market, payer, and financial requirements into scalable product and technology capabilities.

• Establish a clear distinction between:
  • enterprise-owned decisioning and prioritization,
  • foundational data capabilities,
  • execution engines,
  • vendor functionality, and
  • provider, coder, and operational workflows.
• Define the target-state architecture and multi-year roadmap for moving from fragmented tools and processes to a standardized enterprise platform.

Burden of Illness Hub

• Build the Hub as the enterprise system for:

- patient eligibility and prioritization,

- attributed and high-probability unattributed population identification,

- suspect and opportunity aggregation,

- opportunity deduplication,

- clinical and economic prioritization,

- work queue generation,

- intervention routing,

- opportunity status and disposition,

- attribution and retention interventions, and

- enterprise performance analytics.

• Establish common rules and governance for determining when an opportunity should be surfaced, suppressed, combined, escalated, or routed to an alternative intervention.

• Ensure prioritization logic is transparent, measurable, and configurable by population, payer, market, and intervention type.

• Create feedback loops in which outcomes from providers, coders, AI, and other interventions continuously improve future prioritization.

Strategic Leadership

• Own product requirements and prioritization for risk adjustment technology capabilities across the enterprise.

• Partner with Engineering, Data, Architecture, and Clinical Informatics to translate business requirements into scalable technical solutions.

• Define product requirements, user stories, workflows, acceptance criteria, and outcome measures for major capabilities.

• Maintain a prioritized product backlog and roadmap aligned to enterprise objectives.

• Establish appropriate product governance, release planning, testing, adoption, and change-management processes.

• Ensure risk adjustment technology integrates effectively with EHRs, clinical applications, analytics platforms, data infrastructure, and operational systems.

• Evaluate emerging technologies—including AI, NLP, clinical inference, and automation—for their ability to improve identification, prioritization, and capture of clinically appropriate opportunities.

Change Management & Adoption

The Director will ensure that multiple execution channels operate against a common enterprise prioritization strategy, including:

• Point-of-care clinical technology and provider workflows

• Platforms such as Navina

• Coding and chart review teams

• Incremental AI and clinical rules

• Prospective and retrospective interventions

• Provider and coder workflows

• Attribution and patient retention interventions

• Operational outreach and work queues

The Director will define when and how opportunities move between these execution channels and establish clear ownership, handoffs, and disposition logic.

The goal is not simply to generate more suspecting opportunities, but to ensure that the highest-value, clinically appropriate opportunity reaches the most effective intervention at the right time.

Vendor Strategy and Management

• Collaborate with clinical, operational, analytics, finance, compliance, and technology teams to align priorities and execution.

• Lead and mentor multidisciplinary teams including workflow analysts, clinical informatics resources, optimization specialists, and program managers.

• Manage vendor relationships and participate in technology selection and evaluation processes.

• Support enterprise scaling efforts, acquisitions, integrations, and operational transformation initiatives.

Performance & Analytics

• Define and monitor operational and clinical metrics tied to workflow optimization initiatives.

• Use data and analytics to identify inefficiencies, quantify impact, and guide prioritization decisions.

• Develop executive-level reporting demonstrating ROI, adoption, productivity, and quality outcomes.
• Drive continuous improvement methodologies across workflow and technology initiatives.

Experience

• Bachelor’s degree in healthcare administration, nursing, informatics, business, information systems, or related field; advanced degree preferred.
• 10+ years of progressive leadership experience in healthcare operations, clinical informatics, healthcare technology, or workflow optimization, with at least 5 years in a senior leadership role.
• Demonstrated experience leading enterprise clinical transformation or EHR optimization initiatives at scale.
• Proven success driving cross-functional operational and technology initiatives in complex healthcare environments.
• Strong understanding of ambulatory and/or population health clinical workflows.
• Experience with change management, clinician stakeholder engagement, and adoption strategies.
• Track record of translating technology capabilities into measurable clinical and operational outcomes.

Preferred Experience

• Advanced degree (MHA, MBA, MS in Informatics, or equivalent).
• Certification or demonstrated proficiency in EHR workflow optimization.
• Experience implementing ambient AI documentation tools or AI-enabled clinical decision support.
• Background in process improvement methodologies (Lean, Six Sigma, or equivalent).
• Experience in a multi-entity or integrated healthcare delivery system spanning primary care, specialty, and value-based care models.

Technical Fluency

• Working knowledge of EHR platforms and clinical workflow configuration, particularly Athena.
• Familiarity with AI-enabled clinical tools, telehealth platforms, and digital health technologies and their integration into clinical workflows.
• Understanding of population health platforms and care management tools.
• Ability to translate workflow and technology concepts clearly across clinical, operational, and technical audiences.

Skills & Competencies

• Executive presence with the ability to communicate clinical technology strategy to senior clinical, operational, and business audiences.
• Strong instincts for driving adoption and behavior change across large, distributed clinical populations.
• Cross-functional collaboration and stakeholder management — this leader earns credibility by delivering change that clinicians experience as meaningful improvement.
• Commitment to measurable outcomes, continuous improvement, and evidence-based decision-making.
• Ability to lead through managers and analysts, setting direction and holding teams accountable to a high standard.

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Compensation Range:

$165,951.00

to

$248,926.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Originally posted on Himalayas