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Director, Prospective + Concurrent Risk Adjustment Products

Director, Prospective + Concurrent Risk Adjustment Products

West Virginia StaffingCharleston, WV, US
8 days ago
Job type
  • Full-time
Job description

Director Of Prospective + Concurrent Risk Adjustment Products

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare.

As the Director of Prospective + Concurrent Risk Adjustment Products, you will lead the strategy, roadmap, and execution for the product portfolio focused on identifying and acting on undiagnosed conditions (prospective suspecting) and ensuring risk adjustment coding accuracy in near real-time (concurrent review). You will manage a cross-functional team of product managers and product designers and collaborate deeply with data science, clinical experts, engineering, and commercial teams to accelerate innovative solutions that surface timely, high-accuracy clinical insights directly into provider workflows. These capabilities help health plans and risk bearing groups improve revenue integrity, close care gaps earlier, and enable better care decisions at the point of service. This is a leadership role that combines strategic thinking, clinical product development expertise, and people management responsibilities. You'll be accountable for ensuring our products deliver measurable impact for value-based care customers while building a high-performance team and culture.

Key Responsibilities

  • Product Strategy :

Own and evolve the product vision, strategy, and roadmap for the Prospective Suspecting and Concurrent Review solutions within Datavant's Clinical Insights Platform suite.

  • Define multi-year plans aligned to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement.
  • Identify and prioritize use cases that leverage AI / ML and real-time data signals to surface high-impact suspects and coding opportunities.
  • Drive innovation leveraging interoperability standards (FHIR, HL7, APIs) to enable seamless enablement with EHRs, care management platforms, and third party integrations.
  • Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions.
  • Execution & Delivery :

    • Lead the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.

  • Work closely with Engineering and Data Science to build predictive models and real-time data pipelines that power suspecting and concurrent workflows.
  • Ensure products are clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations.
  • Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and concurrent coding capture and correction rates.
  • Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption).
  • Stakeholder Engagement :

    • Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk bearing provider groups).

  • Lead customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and concurrent coding needs.
  • Present product strategy and roadmap updates to executive stakeholders and client advisory boards.
  • Represent Datavant in industry conversations on emerging regulations and best practices related to prospective risk capture and concurrent review.
  • Compliance & Quality :

    • Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).

  • Implement and monitor processes that ensure defensibility of all outputs, documentation standards, and audit trails.
  • Design and embed audit readiness into product workflows, ensuring all activities are traceable, evidence-backed, and aligned with CMS documentation requirements.
  • Provide strategic recommendations and decision frameworks when trade-offs between revenue, compliance, and user experience arise.
  • Leadership & Culture :

    • Build, lead, and coach a team of Product Managers working across different facets within prospective and concurrent solutions.

  • Provide mentorship, performance management, and career development aligned with Datavant's leadership principles and growth culture.
  • Establish best-in-class product practices and instill a culture of experimentation, feedback, and continuous learning.
  • Support resourcing and hiring plans as product needs evolve and grow.

    • Key Qualifications

  • Required :

    • 8+ years of product management experience in healthcare, including ownership of clinical, risk adjustment, or provider-facing solutions.

  • Proven leadership experience managing multi-disciplinary product teams, including hiring, mentoring, performance management, and scaling organizations to deliver complex healthcare technology solutions.
  • Solid understanding of clinical suspecting, concurrent coding workflows, risk adjustment models (e.g., CMS-HCC, HHS-HCC), and code sets / clinical vocabularies (ICD, LOINC, RxNorm).
  • Expertise in healthcare interoperability standards (FHIR, HL7, CCD, Direct Messaging) and experience delivering API-driven, cross-platform solutions.
  • Demonstrated ability to define strategy, lead cross-functional execution, and manage product teams.
  • Excellent communication skills; able to bridge technical, clinical, and business conversations with credibility.
  • Bachelor's degree in a related field (healthcare, business, technology).
  • Preferred :

    • Experience with AI / ML models for disease prediction or real-time coding suggestions.

  • Background in working with provider documentation teams, coders, or concurrent review vendors.
  • Clinical experience or deep engagement with clinician stakeholders.
  • Familiarity with audit requirements, medical record standards, and regulatory guidance impacting concurrent coding or risk adjustment.
  • Product experience integrating into EHRs or care management platforms.

    • Key Performance Indicators (KPIs)

  • Product Impact :

    • Suspect accuracy and clinical validation rates

  • Risk capture lift and change rates through concurrent workflows
  • Provider adoption and engagement metrics
  • Chart completion rates and documentation improvement indicators
  • Team & Execution :

    • Roadmap delivery pace and quality

  • Team engagement, retention, and OKR progress
  • Cross-functional collaboration and stakeholder satisfaction
  • Business & Strategic Outcomes :

    • Revenue and margin contribution from clinical insights

  • Customer expansion tied to prospective or concurrent modules
  • Market recognition and competitive differentiation

    • You will play a crucial role in expanding a platform that empowers clinicians with data-driven disease predictions, improving clinical decision-making, patient outcomes, and healthcare efficiency. Your work will directly impact how healthcare providers deliver value-based care and ensure patients receive the most appropriate interventions.

    Datavant is committed to building a diverse team of Datavanters who are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

    To learn more about our commitment, please review our EEO Commitment Statement here. Know Your Rights, explore the resources available through the EEOC for more information regarding your legal rights and protections.

    In addition, Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, by selecting the 'Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here.

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