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VP, Risk Adjustment & HEDIS

VP, Risk Adjustment & HEDIS

Strive HealthWashington, DC, US
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VP, Risk Adjustment & HEDIS

At Strive Health, we're driven by a purpose : transforming the broken kidney care system. Through early identification, engagement, and comprehensive coordinated care, we significantly improve outcomes for people with kidney disease, reducing emergency dialysis and inpatient utilization. Our high-touch care model integrates with local providers and uses predictive data to identify and support at-risk patients along their entire care journey. We embrace diversity, celebrate successes, and support each other, making Strive the destination for top talent in healthcare. Join us in making a real difference.

The Vice President, Risk Adjustment & HEDIS will be responsible for leading Strive Health's risk adjustment, HEDIS, and quality performance strategy across our internal care teams and external provider network. This leader will drive the development, execution, and operationalization of programs that ensure accurate documentation, optimized performance in risk adjustment and quality metrics, and compliance with federal programs such as CKCC. This role is a blend of strategic leadership, operational execution, and external engagementrequiring the ability to partner effectively with nephrologists, primary care physicians, and internal clinical teams while overseeing analytics, vendor relationships, incentive alignment, and the adoption of emerging technologies.

Strategic Leadership

  • Develop and lead enterprise-wide strategy for risk adjustment, HEDIS performance, and quality improvement in kidney care.
  • Drive alignment of risk adjustment and quality goals across Strive Health, regional care teams, and external network providers.
  • Partner with executive leadership to ensure integration of risk and quality strategies into broader company objectives.

Performance & Operational Execution

  • Own operational accountability for CKCC program performance, ensuring compliance, optimization, and long-term sustainability.
  • Lead the design and implementation of workflows and tools that enable NPs, RNs, Regional Medical Directors, and other clinicians to accurately document conditions and close quality gaps.
  • Manage vendor partnerships to ensure delivery of high-value risk adjustment and quality services.
  • Oversee analytics and reporting capabilities that measure, track, and forecast performance.
  • Leverage AI and emerging technologies to enhance coding accuracy, automate quality gap closure, and deliver predictive insights to care teams.
  • Establish and manage incentive programs (internal and external) that align behavior with desired outcomes.

    • Provider Engagement & Collaboration

  • Build strong partnerships with nephrologists, PCPs, and network partners to operationalize coding, documentation, and quality improvement initiatives.
  • Lead education and engagement strategies for clinicians, ensuring adoption of best practices and new tools.
  • Serve as a trusted partner to both internal care teams and external physicians in sustained performance.

    • Minimum Qualifications

  • Bachelor's Degree in a relevant field.
  • 10+ years of healthcare experience, with 7+ years in risk adjustment, quality / HEDIS, or related value-based care functions.
  • Ability to travel and be onsite to meet business needs.

    • Preferred Qualifications

  • 6+ years of experience managing direct reports, including 2+ years managing direct reports at the Director level (or greater).
  • Deep expertise in risk adjustment (CMS-HCC, ESRD models, and CKCC program experience strongly preferred).
  • Proven track record of developing and executing strategies that drive measurable performance in both risk adjustment and quality outcomes.
  • Strong operational leadership experience, including vendor management, analytics oversight, and workflow design.
  • Demonstrated ability to implement and scale AI-driven solutions and emerging technologies in healthcare operations.
  • Experience leading provider engagement programs, including education, incentives, and clinical adoption.

    • About You

  • Exceptional ability to collaborate cross-functionally across clinical, operations, analytics, and executive teams.
  • Executive presence with strong communication and influencing skills.
  • Passion for advancing value-based care and improving outcomes for patients with chronic kidney disease.
  • Proven ability to lead and develop high-performing teams, with a strong focus on fostering collaboration and driving results.
  • Strong problem-solving skills with the ability to thrive in a fast-paced, dynamic environment.

    • Annual Base Salary Range : $173,000 - $225,000

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