Program Director Medicare Quality Incentive Program
Program Director Medicare Quality Incentive Program
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Job Description
PROGRAM DIRECTOR MEDICARE QUALITY INCENTIVE PROGRAM (HEALTHCARE)
Work from home (telecommute) within Oregon Washington Idaho or Utah
Build a career with purpose. Join our Cause to create a personfocused and economically sustainable health care system.
Who We Are Looking For:
Every day Cambias Medicare Quality Team is living our mission to make health care easier and lives better. The Program Director Medicare Provider Enablement provides leadership to implement provider enablement for the Medicare Advantage and Individual lines of business. This position drives the organization to achieve market competitive performance results related to Medicare Advantage Star Ratings Risk Adjustment and select quality improvement initiatives through effective provider engagement and in compliance with CMS standards all in service of making our members health journeys easier.
If youre a motivated and experienced People Leader with Medicare experience looking to make a difference in the healthcare industry apply for this exciting opportunity today!
What You Bring to Cambia:
Preferred Key Experience:
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
MUST BE a people leader within a healthcare or Payer Health Plan environment.
Qualifications and Certifications:
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.
Skills and Attributes (Not limited to):
Expertise regardingMedicare Advantageand with CMS Stars Program and related clinical financialand operational metrics.
Experience related tovaluebasedcontracting / 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 revenueto drive line of businesssuccess.
Demonstrated ability to provide oversight and understanding ofprovider operationsand toinfluencechange in order to improveprovidersclinical andfinancialperformance invaluebasedarrangements.
Proven business acumen including understanding of market dynamics financial/budget management data analysis and decision making.
Ability toexecutebusiness strategies andcreate and executeactionplans anddrive results across internal teams and/orproviderpartners.
Ability to effectively engage with vendors and provider partners.
Demonstrated ability to managelead 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
What You Will Do at Cambia (Not limited to):
Imparts unique Medicare businessmodel expertise both internally and externally that is needed to deliver profit including levers revenue and costs initiatives.
Owns the strategic longterm development of innovative provider incentive programs that ensure achievement of Medicare Advantage business goals and objectives.
Accountable for the annual implementation and of the Medicare Quality Improvement Program including analytics project management reporting and compliance.
Collaborates with NMPPI to provide leadershipand insights for the creation and of progressive valuebased arrangements (VBAs) designed to drive growth and Gain in the Medicare lines of business.
Participates in executivelevel external provider meetings designed to persuade providers to view Regence as a Medicare payor of choice demonstrating Regences 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 performancestrategies direction and ofaction plans for Risk Adjustment Starsincentive programsandoverall provider financial performance forthe Medicare Advantage line of business.
Ensures enterprisewide 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.
Represent Medicare lines of business in enterprise projects intended to improve processes/functionality for provider performance in VBAs.
Provider incentives (QIP): Program development monitoring attribution
Drive provider engagementin clinical programs (CCM DM PCetc)
Drive RA/Starsprovider levelperformance strategies; action plans
MA representation atproviderconversationsas appropriate
Collaborate on delegation/capitation roadmap/implementation (MA only)
RA Risk Mitigationand providereducation;RA Medicare etc. as driven by RM results/data
The expected hiring range for The Program Director Medicare QIP is $130k$166k depending on skills experience education and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15. The current full salary range for this position is $113k Low/ $142k MRP / $185k High
About Cambia
Working at Cambia means being part of a purposedriven awardwinning culture built on trust and innovation anchored in our 100 year history. Our caring and supportive colleagues are some of the best and brightest in the industry innovating together toward sustainable personfocused health care. Whether were helping members lending a hand to a colleague or volunteering in our communities our compassion empathy and team spirit always shine through.
Why Join the Cambia Team
At Cambia you can:
- Work alongside diverse teams building cuttingedge solutions to transform health care.
- Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambiasupported outreach programs.
- Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck and your compensation should be too. Our compensation package includes competitive base pay as well as a marketleading 401(k) with a significant company match bonus opportunities and more.
In exchange for helping members live healthy lives we offer benefits that empower you to do the same. Just a few highlights include:
- Medical dental and vision coverage for employees and their eligible family members including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 companypaid holidays.
- Marketleading retirement plan including a company match on employee 401(k) contributions with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Awardwinning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobaccofree workplace. All qualified applicants will receive consideration for employment without regard to race color national origin religion age sex sexual orientation gender identity disability protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability please email . Information about how Cambia Health Solutions collects uses and discloses information is available in our .
Required Experience:
Director
Employment Type
Full-Time
