Program Director Medicare Quality Incentive Program
| Company | Cambia Health Solutions |
|---|---|
| Location | Salt Lake City, UT, USA, Post Falls, ID, USA, Yakima, WA, USA, Tacoma, WA, USA, Medford, OR, USA, Burlington, WA, USA, Tukwila, WA, USA, Salem, OR, USA, Boise, ID, USA, Pocatello, ID, USA, Spokane, WA, USA, Moscow, ID, USA, Bellevue, WA, USA, Portland, OR, USA, Bend, OR, USA |
| Salary | $130000 – $166000 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior, Expert or higher |
Requirements
- BA/BS degree in Business, Health Care Administration and/or social sciences or clinically related
- 10 years of experience working with physicians or health plans or equivalent combination of education and experience
- MUST BE a people leader within a healthcare or Payer Health Plan environment
- Expertise regarding Medicare Advantage and Medicare
- Familiarity with CMS Stars Program and related clinical, financial and operational metrics
- Experience related to value-based contracting / performance
- Ability to manage to metrics and drive collaboration across functionally diverse groups to improve provider performance and member outcomes
- Experience related to health insurance revenue to drive line of business success
- Demonstrated ability to provide oversight and understanding of provider operations and to influence change in order to improve providers’ clinical and financial performance in value-based arrangements
- Proven business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making
- Ability to execute business strategies and create and execute action plans and drive results across internal teams and/or provider partners
- Ability to effectively engage with vendors and provider partners
- Demonstrated ability to manage, lead high performing teams and to organize and support cross functional activities to deliver results in a complex, matrix organizational structure
- Ability to analyze, provide insight and direction, and act upon data
Responsibilities
- Imparts unique Medicare business-model expertise, both internally and externally, that is needed to deliver profit, including levers revenue and costs initiatives
- Owns the strategic, long-term development of innovative provider incentive programs that ensure achievement of Medicare Advantage business goals and objectives
- Accountable for the annual implementation and execution of the Medicare Quality Improvement Program including analytics, project management, reporting and compliance
- Collaborates with NMPPI to provide leadership and insights for the creation and execution of progressive value-based arrangements (VBAs), designed to drive growth and Gain in the Medicare lines of business
- Participates in executive-level external provider meetings designed to persuade providers to view Regence as a Medicare ‘payor of choice’, demonstrating Regence’s consultative Medicare acumen and value as a partner
- Manages the Government Programs resources intended to enable providers’ success in achieving quality and financial performance in Medicare lines of business
- Guides internal partners’ planning and implementation of provider performance strategies, direction, and execution of action plans for Risk Adjustment, Stars, incentive programs and overall provider financial performance for the Medicare Advantage line of business
- Ensures enterprise-wide compliance with CMS expectations of a Medicare Advantage Organization (MAO) specific to provider partnerships
- Acts as Directing Sponsor for specific strategic investment initiatives aimed at operating our Medicare gap closure calculations, QIP oversight and workflows
- Represents Medicare lines of business in enterprise projects intended to improve processes/functionality for provider performance in VBAs
- Provider incentives (QIP): Program development, monitoring, execution, attribution
- Drive provider engagement in clinical programs (CCM, DM, PC, etc)
- Drive RA/Stars provider level performance strategies; action plans
- MA representation at provider conversations as appropriate
- Collaborate on delegation/capitation roadmap/implementation (MA only)
- RA Risk Mitigation and provider education; RA, Medicare, etc. as driven by RM results/data
Preferred Qualifications
- This person must be highly strategic around Provider engagement
- Needs to ensure we meet our Provider performance targets and work with The Provider Engagement Director in Network to develop engagement plans
- Needs operational skills to oversight the provider incentive payment process