Principal, Risk Adjustment

Corewell Health
Corewell Health

Grand Rapids, MI, USA

Posted on Jul 21, 2026
Job Summary

The Principal, Risk Adjustment, is a director-level strategic leader responsible for cross-functional collaboration to drive enterprise risk adjustment performance, supporting new market acquisition and expansion, and leading high-impact, scalable program initiatives from concept through execution. This role provides leadership across risk adjustment strategy, trend management, provider engagement, operational execution, compliance, vendor oversight & technology enablement. The role will drive cost saving measures, improve operational efficiencies, and increase provider engagement and regulatory compliance.

Essential Functions

  • Strategic Leadership & Market Expansion: Lead risk adjustment strategy for new market acquisition, expansion, and operational readiness. Assess market-specific risk adjustment opportunities, operational gaps, provider capabilities, and technology requirements. Develop & execute scalable risk adjustment playbooks for new & existing markets. Partner with executive leadership & cross-functional stakeholders to align risk adjustment strategies with enterprise growth, revenue integrity, quality & value-based care objectives. Ensures department policies, programs, and plans are consistent with and support Priority health’s core values and mission.

  • Program Development & Execution: Lead risk adjustment initiatives from ideation & business case development through implementation, monitoring & continuous improvement. Define program objectives, success metrics, timelines, resource needs, risks, and operational dependencies. Oversee & support implementation of prospective, concurrent & retrospective risk adjustment programs. Drive process standardization across markets and vendors. Monitor initiative performance & develop corrective action plans to close gaps in execution or outcomes.

  • Trend Management & Performance Oversight: Lead trend management for all risk adjustment initiatives, including development, implementation, monitoring, reporting, and optimization. Analyze trends and financial impacts and make recommendations for gap closure. Partner with Analytics & Actuary teams to forecast performance, identify improvement opportunities, and quantify revenue impact. Develop executive-level reporting & dashboards to track performance against targets. Identify emerging risks, market variation, provider performance issues, data gaps, and operational barriers impacting risk adjustment outcomes.

  • Provider Engagement & Technical Enablement: Lead implementation of provider-facing technical applications and workflows that support risk adjustment accuracy and documentation improvement. Partner with IDA/DS, Analytics, Clinical Operations, and external vendors and providers to integrate risk adjustment tools into EMR/EHR platforms and provider workflows. Ensure provider facing tools are scalable across markets. Collaborate with Provider Network and external providers to support adoption, training, workflow redesign and performance accountability.

  • Operational Governance & Compliance: Establish governance, controls, and monitoring processes for risk adjustment initiatives & technology-enabled workflows. Ensure risk adjustment activities comply with CMS requirements, coding guidelines, documentation standards, HIPAA, and internal compliance policies. Partner with Compliance and Audit teams to support RADV readiness, internal audits, chart review governance, and remediation plans. Develop policies, procedures, operating models, and controls to support sustainable & compliant risk adjustment operations.

  • Cross-Functional Leadership: Partner with market leadership, provider engagement, clinical operations, finance, actuarial, analytics, compliance, IDA/DS, product and vendor partners. Influence stakeholders across a matrixed organization to drive alignment, accountability, and execution. Lead steering committee updates, executive briefings, and cross-functional workgroups. Translate complex risk adjustment insights into actionable business strategies & operational priorities. Provide leadership, coaching, and direction to project teams, analysts, market partners, and operational stakeholders.

  • Vendor & Partner Management: Lead and participate in evaluating, selecting and managing vendors supporting risk adjustment. Support defining vendor performance expectations, service-level metrics, implementation timelines, and quality standards. Monitor vendor outcomes, resolve issues, and ensure alignment with enterprise objectives and compliance requirements. Partner with procurement, legal, compliance, and finance on contracting, performance reviews, and ongoing governance.

Qualifications

  • Bachelor's Degree in business, health care administration or related clinical field. Required
  • Master's Degree in business, health care administration or related clinical field. Preferred
  • 12 years of relevant experience Strong Risk Adjustment and Project Management experience with a detailed understanding of Enterprise Risk Management & Risk Adjustment for MA & ACA LOB Required
  • CRT-ScrumMaster, Certified (CSM) - Required
  • CRT-Lean Six Sigma Black Belt Certification (CSSBB) - Preferred
  • CRT-Project Management Professional (PMP) - PMI - Preferred

Physical Demands

  • Pallet to Waist (6" from floor) > 5 lbs: Seldom

  • Waist to Waist > 5 lbs: Seldom

  • Waist to Chest (below shoulder) > 5 lbs: Seldom

  • Waist to Overhead > 5 lbs: Seldom

  • Bilateral Carry > 5 lbs: Seldom

  • Unilateral Carry > 5 lbs: Seldom

  • Pushing Force > 5 lbs: Seldom

  • Pulling Force > 5 lbs: Seldom

  • Sitting: Frequently

  • Standing: Occasionally

  • Walking: Occasionally

  • Forward Bend - Standing: Seldom

  • Forward Bend - Sitting: Occasionally

  • Trunk Rotation - Standing: Seldom

  • Trunk Rotation - Sitting: Occasionally

  • Reach - Above Shoulder: Seldom

  • Reach - at Shoulder or Below: Seldom

  • Handling: Occasionally

  • Forceful Grip > 5 lbs: Seldom

  • Forceful Pinch > 2 lbs: Seldom

  • Finger/Hand Dexterity: Frequently


How Corewell Health cares for you

  • Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
  • On-demand pay program powered by Payactiv
  • Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
  • Optional identity theft protection, home and auto insurance
  • Traditional and Roth retirement options with service contribution and match savings
  • Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids

Department Name

Risk Adjustment Executive - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

40

Days Worked

Monday-Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

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