Morgan Consulting Resources, Inc. has been retained to conduct the search for the newly created position of Vice President, Risk Adjustment with Inland Empire Health Plan. This highly visible leadership role will work on-site at IEHP’s Home Office, located at 10801 6^th St., Rancho Cucamonga, CA with a remote schedule on Mondays and Fridays.

About the Organization:

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 29th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 8,000 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.

IEHP has consistently achieved outstanding employee engagement scores from their 4,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! For details regarding IEHP, please visit: iehp.org 

About the Position:

Reporting to the Chief Financial Officer (CFO), the Vice President of Risk Adjustment (VP) will define and lead the enterprise vision and strategy for risk adjustment (RA) across all IEHP product lines, ensuring alignment with the organization’s mission and long-term financial sustainability. This senior leader will oversee risk adjustment programs that drive accurate risk scores, optimize revenue, and ensure regulatory compliance, while integrating risk adjustment into value-based care initiatives. In close partnership with finance, actuarial, quality, and clinical leaders, the VP will forecast revenue, manage financial risk, and enhance provider engagement through education, incentives, and value-based programs. The role provides oversight of audits and program integrity, establishes key performance indicators, and champions innovation through analytics, optimization, and technical solutions. As a senior leader, the VP will build and mentor high-performing teams, manage vendor and partner relationships, and anticipate regulatory changes related to risk adjustment programs to ensure organizational readiness. The VP will evaluate current processes, identify gaps, and implement innovative solutions that improve coding accuracy and strengthen revenue capture. This role requires a visible, influential leader who can clearly communicate strategy and performance to executives, key stakeholders, providers, and regulatory bodies. The role is accountable for reporting performance results, providing strategic recommendations to executive leadership, and ensuring transparency, financial sustainability, and alignment with the organization’s mission.

Responsibilities: 

• Define and execute the enterprise vision for risk adjustment across all product lines, aligning strategies with IEHP’s mission, business objectives, and long-term financial sustainability.
• Provide strategic leadership and enterprise oversight of programs that deliver accurate risk scores and optimized revenue while ensuring full compliance with CMS, DHCS, and Covered California regulations.
• Embed risk adjustment into quality, performance, and value-based care initiatives while partnering with Finance, Actuarial, Quality and Clinical leaders to forecast revenue and manage financial risk.
• Develop and implement impactful provider engagement strategies, including education, incentives, and value-based initiatives that strengthen documentation accuracy and coding best practices.
• Provide executive oversight of internal and external audit functions and architect enterprise-wide program integrity frameworks that ensure regulatory compliance, mitigate organizational risk, and safeguard revenue accuracy across all lines of business.
• Establish key performance indicators, dashboards, and reporting systems while advancing EMR optimization, analytics, and technology solutions that drive continuous improvement.
• Build, mentor, and lead high-performing teams while providing strategic oversight of vendors and delivery system partners to ensure operational excellence and accountability. Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines.
• Anticipate regulatory changes, ensure organizational readiness, and serve as a visible executive leader who effectively communicates strategy and performance to providers, regulators, and stakeholders.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful. 

Short-term Goals: Advance IEHP’s Risk Adjustment program by gaining a clear understanding of the end-to-end data flow, strengthening coordination across key departments, and ensuring information moves accurately through the systems, vendor processes and ultimately to regulatory agencies, as applicable. Establish consistent communication routines and evaluate team strengths to support ongoing operational excellence.

Long-term Goals: Develop and lead a comprehensive RA strategy that enhances data integrity, supports cross-functional alignment, and drives continued improvement in Medicare, Medi-Cal, and ACA performance. Build a cohesive, high-performing team and foster strong partnerships across the organization to support a comprehensive and efficiently integrated RA program.

Team Structure: Current RA staffing includes a Manager of Risk Coding, Covered California and a Manager of Risk Adjustment, Medicare. Each leader has 8-9 team members reporting to them with a total of 16 team members reporting up to the VP.

Minimum Qualifications:

• Master’s degree in business, Health Administration, or related field from an accredited institution required.
• In lieu of the required degree, a minimum of four (4) years of additional relevant progressive work experience is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.
• Ten (10) years of progressive leadership experience in health plan operations, risk adjustment, or related functions.
• Demonstrated success leading risk adjustment strategy across multiple product lines. Proven success in developing and executing enterprise-level strategies.
• Expert comprehensive knowledge and understanding of Medicare Advantage, Medi-Cal, and ACA risk adjustment methodologies and regulations.
• Expert comprehensive knowledge and understanding of medical coding, provider engagement, and risk adjustment compliance standards.
• Financial acumen with expertise in revenue optimization and risk management.
• Operational knowledge of coding standards (ICD-10, HCC) and clinical documentation.
• Healthcare economics, population health, and value-based care frameworks.
• Excellent communication, executive presence, interpersonal, and relationship building skills.
• Excellent analytical, critical thinking, and problem-solving skills.
• Collaborative leader with ability to drive influence across the organization. Strategic thinker with strong business acumen. Data-driven and outcomes-focused.

About Morgan Consulting Resources, Inc.

Morgan Consulting Resources is a woman-owned, nationally retained executive search firm with over two decades of experience filling executive roles at healthcare payers and providers and the vendors that support them. Founded by healthcare industry executives, we’re an exclusive firm that only takes on a select number of searches at a time so that we can focus on finding the best possible candidates as quickly as possible for our clients.

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