Lead, Organic Risk Adjustment

Work from home Full-time role Hiring

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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. This individual will play a key role in shaping and evolving the Organic Risk Adjustment program while helping the organization rethink how risk adjustment opportunities are identified, prioritized, and embedded within routine provider workflows. The role will partner closely with clinical, operational, analytical, and business leaders across the enterprise to improve program performance and build sustainable capabilities that drive long-term impact.

Key Responsibilities

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.

Use your skills to make an impact

This role is not eligible for work visa sponsorship.

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 connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade 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 Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$115,200 - $158,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.Application Deadline: 11-02-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.

Demonstrated success leading large-scale cross-functional initiatives; experience in Medicare Advantage, value-based care, population health, healthcare operations, quality improvement, or risk adjustment; ability to influence stakeholders and analyze data; strong communication and problem-solving skills.