Program Director Medicare Quality Incentive Program

Regence; Bend (OR); On-site; USD 130,000 - 166,000; Full time

Job summary

An established industry player is seeking a Program Director for their Medicare Quality Incentive Program. This role is pivotal in leading provider engagement and ensuring compliance with CMS standards to enhance Medicare Advantage performance. The ideal candidate will possess extensive experience in healthcare, particularly in Medicare Advantage, and will be responsible for developing innovative incentive programs that align with business goals. With a focus on strategic leadership and operational excellence, this position offers an opportunity to make a significant impact on healthcare quality and provider relationships. Join a dynamic team dedicated to improving lives and healthcare outcomes.

Benefits

Medical, dental and vision coverage

Generous paid time off

Company-paid holidays

Market-leading retirement plan

Qualifications

• 10+ years of experience in healthcare or Payer Health Plan environments.
• Strong strategic and operational skills in provider engagement.

Responsibilities

• Lead the implementation of provider incentive programs for Medicare Advantage.
• Ensure compliance with CMS standards and improve provider performance.

Skills

Medicare Advantage expertise

Provider engagement

Operational oversight

Business acumen

Data analysis

Team leadership

Value-based contracting

Education

BA/BS in Business

Healthcare Administration

Social sciences or clinically related

Job description

Program Director Medicare Quality Incentive Program

Join to apply for the Program Director Medicare Quality Incentive Program role at Regence BlueCross BlueShield of Oregon.

PROGRAM DIRECTOR MEDICARE QUALITY INCENTIVE PROGRAM (HEALTHCARE)

Work from home (telecommute) within Oregon, Washington, Idaho or Utah.

Who We Are Looking For
Every day, Cambia’s 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.

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 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.
• 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.
• 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.

What You Will Do At Cambia (Not Limited To)

• 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.
• Ensures enterprise-wide compliance with CMS expectations of a Medicare Advantage Organization (MAO) specific to provider partnerships.

The expected hiring range for The Program Director Medicare Provider Enablement 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%.

About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history.

Benefits
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.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. A background check is required.