Program Director Medicare Quality Incentive Program

Regence BlueCross BlueShield of Oregon; Salem (OR); Hybrid; USD 113,000 - 185,000; Full time

Job summary

An established industry player is seeking a Program Director for their Medicare Quality Incentive Program. This role involves leading provider engagement strategies and overseeing incentive payment processes to enhance Medicare Advantage Star Ratings and compliance with CMS standards. The ideal candidate will have extensive experience in healthcare administration and a strong grasp of Medicare Advantage metrics. Join a purpose-driven organization that values community, innovation, and career growth opportunities.

Benefits

Competitive benefits

Career growth opportunities

Purpose-driven culture

Qualifications

• 10+ years of experience working with physicians or health plans.
• Expertise in Medicare Advantage and CMS Stars Program.

Responsibilities

• Lead provider engagement strategies to meet performance targets.
• Oversee provider incentive payment process and develop programs.

Skills

Leadership skills

Strategic planning

Operational skills

Provider engagement

Medicare Advantage expertise

Education

BA/BS in Business

Healthcare Administration

Social Sciences

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.

This position is based in Oregon, Washington, Idaho, or Utah, and offers a work-from-home option.

About the Role

The Program Director, Medicare Provider Enablement, provides leadership to implement provider enablement strategies for Medicare Advantage and Individual lines of business. The role focuses on achieving performance results related to Medicare Advantage Star Ratings, Risk Adjustment, and quality improvement initiatives through effective provider engagement, ensuring compliance with CMS standards.

Key Responsibilities

• Lead provider engagement strategies to meet performance targets.
• Oversee the provider incentive payment process.
• Develop and execute provider incentive programs, including QIP and value-based arrangements.
• Collaborate with internal and external stakeholders to improve provider performance and member outcomes.
• Ensure compliance with CMS regulations and standards.

Qualifications

• BA/BS in Business, Healthcare Administration, Social Sciences, or related fields.
• Minimum of 10 years' experience working with physicians, health plans, or equivalent.

Preferred Skills

• Expertise in Medicare Advantage, CMS Stars Program, and clinical/financial metrics.
• Experience in value-based contracting and managing provider performance.
• Strong leadership, strategic, and operational skills.

Compensation

The hiring range is $130,000–$166,000, with a target bonus of 15%. Full salary range: $113,000 - $185,000, depending on experience and location.

Why Join Cambia?

We offer a purpose-driven culture, competitive benefits, career growth opportunities, and a commitment to community and innovation.