Director, Risk Adjustment Products

Director, Risk Adjustment Products

Director II - Product Management

Who We Are:

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

You Are:

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with technical and operations teams, both internally and externally, to create innovative solutions that deliver measurable impact for our customers. This is a leadership role where you will pair your product development and people management expertise to mentor a high-performance team.

The Opportunity:

• Define multi-year plans aligned to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement.
• Identify and prioritize use cases that leverage AI/ML and real-time data signals to surface high-impact suspects and coding opportunities.
• Drive innovation leveraging interoperability standards (FHIR, HL7, APIs) to enable seamless enablement with EHRs, care management platforms, and third-party integrations.
• Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions.
• Lead the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.
• Work closely with Engineering and Data Science to build predictive models and real-time data pipelines that power suspecting and concurrent workflows.
• Ensure products are clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations.
• Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and concurrent coding capture and correction rates.
• Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption).
• Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk bearing provider groups).
• Lead customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and concurrent coding needs.
• Present product strategy and roadmap updates to executive stakeholders and client advisory boards.
• Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).
• Implement and monitor processes that ensure defensibility of all outputs, documentation standards, and audit trails.
• Design and embed audit readiness into product workflows, ensuring all activities are traceable, evidence-backed, and aligned with CMS documentation requirements.
• Provide strategic recommendations and decision frameworks when trade-offs between revenue, compliance, and user experience arise.
• Build, lead, and coach a team of Product Managers working across different facets within prospective and concurrent solutions.
• Provide mentorship, performance management, and career development aligned with leadership principles and growth culture.
• Establish best-in-class product practices and instill a culture of experimentation, feedback, and continuous learning.
• Support resourcing and hiring plans as product needs evolve and grow.
• Leads the product strategy, development and continuous refinement of the firm's risk adjustment product roadmap, ensuring it aligns with strategic goals and industry best practices
• Leads and manages teams, often geographically dispersed, responsible for risk adjustment activities, ensuring high performance and employee engagement
• Oversee the performance of automated processes, such as AI-driven chart reviews, and ensure operational excellence in risk adjustment operations
• Serve as a subject matter advisor and primary point of contact for health clients, proactively identifying and communicating risks and improvement opportunities, and ensuring client satisfaction
• Contribute to the development of long-range goals and objectives for risk adjustment programs, incorporating best practices and emerging trends
• Work with various departments, including revenue management, coding, and compliance, to align activities and promote objectives
• Build and maintain solid relationships with both internal and external stakeholders, including providers, vendors, and regulatory bodies

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need:

* Bachelor's degree in business or technical field required; Master's degree in business or technical field preferred.

* 10+ years of Risk Adjustment product management experience required.

* 5+ years leadership experience required.

* Experience with Risk Adjustment Products, developing and executing risk adjustment strategies, managing the retrieval and interoperability roadmap, improving retrieval yield, and supporting commercial client growth

* Experience building the product strategy from scratch, creating the roadmap and executing with the Technology and Operation stakeholders.

* Understanding of risk adjustment methodologies, including HCCs, CRGs, and other risk adjustment models used by CMS and commercial health plans.

* Understanding of Medical Record Review, digital channels and interoperability and experience in chart retrieval products or operations.

* Experience with people management, mentorship and creating inclusive and diverse teams.

* Working in AWS cloud environment and experience with AWS cloud services.

* Awareness of Agile tools and methodologies.

* Understanding of SQL, Core Java, Spring Boot, Web Services, XML, JSON, SQL, Middleware, and CI/CD pipeline philosophy.

* Ability to maintain confidentiality.

* Thrives in a dynamic, sometimes ambiguous environment and has a knack for quickly prioritizing needs and creating scalable processes and structure.

* Comfortable in a fully remote environment that relies heavily on asynchronous written collaboration and communication.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $170,000-$225,000

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company's 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.

Guiding Principles

These principles illuminate the path of 'how' we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

* Simplicity

Simplifying complexity underlines everything we do-this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

* Integrity

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

* People-Centricity

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

* Leadership

Taking ownership is about taking initiative, being in-charge and driving things to completion. It's a brave choice to 'own' all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more - their members' well-being.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and "fair chance" ordinances.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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product management,software solutions,project management,healthcare,