Strategic Program Manager - Risk Adjustment & Stars

Alpine Physician Partners; California; On-site; USD 84,000 - 120,000; Full time

Job summary

Alpine Physician Partners seeks a Program Manager, Risk Adjustment & Stars, to bridge coding, data, analytics, IT and operations for Medicare risk adjustment and Star Rating initiatives. You will translate CMS methodologies into actionable plans, drive program cycles, and ensure alignment with business goals.

The role emphasizes cross-functional leadership, RAF trend monitoring, data governance, and collaboration with health plan partners, while adhering to CMS regulations and HIPAA compliance.

Qualifications

• Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field.
• 5–7 years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement, ideally in a VBC setting.
• CRC credential preferred; PMP or similar certification a plus.
• Experience with value-based care, ACOs or delegated risk arrangements; familiarity with multiple health plan Stars programs.

Responsibilities

• Owns the annual risk adjustment and Stars improvement program cycle, coordinating between technical and operational stakeholders.
• Builds and manages program timelines and throughput; reports progress to leadership and partners.
• Leads cross-functional workgroups across coding, quality, IT and analytics; aligns technical work to operational priorities.
• Manages program documentation and requirements; translates between specifications and operational plans.
• Supports RADV audit readiness and health plan data validation requests.

Skills

CMS HCC models

RAF score method

Program management

Cross-functional collaboration

Communication

Data storytelling

Attention to detail

Change management

Education

Bachelor's degree (health informatics / data analytics / healthcare admin / business)

Master's degree preferred

Tools

SQL

Tableau

Power BI

Job description

Alpine Physician Partners seeks a Program Manager, Risk Adjustment & Stars, to bridge coding, data, analytics, IT and operations for Medicare risk adjustment and Star Rating initiatives. You will translate CMS methodologies into actionable plans, drive program cycles, and ensure alignment with business goals.

The role emphasizes cross-functional leadership, RAF trend monitoring, data governance, and collaboration with health plan partners, while adhering to CMS regulations and HIPAA compliance.