Director Healthcare Economics, Risk Adjustment

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Optum Health National Risk Adjustment Healthcare Economics Team leads enterprise-wide risk adjustment analytics and strategy, with a primary focus on Medicare Advantage risk modeling and revenue forecasting. Our work spans in year performance measurement, development of leading indicators tied to risk adjustment outcomes, standardization of forecasting processes, and synthesis of insights for internal stakeholders and executive leadership.

We serve as trusted analytical partners to finance, operations, accounting, and clinical leaders-helping identify opportunities, forecast risk scores and revenue, and interpret complex risk adjustment dynamics. If you are enthusiastic about risk adjustment and thrive in a data-driven environment, this is the place to make an impact.

As a Director and thought leader in Risk Adjustment, you will guide key strategic initiatives related to Medicare Advantage data, reporting, and analytic innovation. You will collaborate with senior leadership, technical teams, and subject matter experts to shape processes, elevate analytic rigor, and ensure insights are accurate, actionable, and aligned to enterprise priorities.

Success in this role requires deep expertise with CMS Medicare Advantage payment models, as well as advanced proficiency accessing, structuring, and analyzing large datasets using SQL, SAS, or similar analytical tools.

You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Advise a highly skilled technical team that analyzes data to drive risk adjustment analytics primarily for the Medicare Advantage population
• Partner with business stakeholders to understand analytical needs, shape strategy, and oversee execution of analytics, reporting, and solution development
• Provide clear, data driven insights to national and regional leaders on performance trends, opportunities, and improvement priorities
• Guide the development and adoption of best in class processes, tools, and capabilities to support data reconciliation, minimize data leakage, and risk adjustment insights
• Oversee creation of concise, executive ready summaries of analytical findings across multiple channels (presentations, dashboards, email updates, and verbal briefings)
• Educate stakeholders of various knowledge levels on the topic of Risk Adjustment from various vantage points-the clinical, operational, and financial
• Direct the operationalization of scalable reporting and flexible analytic infrastructure to support evolving KPIs and business growth
• Leverage enterprise-wide capabilities to support business objectives and deliver integrated solutions
• Provide mentorship, technical guidance, and development support to junior analysts and team members

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 7+ years of healthcare analytics experience focused on risk adjustment, including 3+ years in a leadership or strategic role
• Experience with CMS Medicare Advantage data files (MMR, MOR, MAO 004) supporting forecasting, reconciliation, or program performance analysis
• Proficiency in SQL, Snowflake, Python, or similar tools for large-scale data management
• Expert-level understanding of CMS Risk Adjustment models and their application to revenue forecasting and analytics
• Advanced analytic skills including data analysis, manipulation, extraction, and reporting

• Demonstrated ability to lead complex analytics initiatives and collaborate across cross functional teams

Preferred Qualifications:

• Experience with advanced forecasting methodologies in a healthcare environment
• Broader familiarity with CMS regulations and specifications beyond Medicare Advantage risk adjustment
• Skilled in project management and documentation practices
• Experience supporting finance or revenue-focused teams
• Experience in predictive modeling, advanced data manipulation, and complex reporting
• Ability to synthesize analysis into actionable, visually compelling insights
• Experience measuring ROI and evaluating the impact of operational programs
• Excellent communication skills with experience presenting technical concepts to executive audiences

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $64.71 to $110.96 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.