Program Director - Quality Incentive Program

PROGRAM DIRECTOR - QUALITY INCENTIVE PROGRAM (QIP) (HEALTHCARE)
Onsite/Onsite-Flex (In office every Tues/Wed/Thurs - Either Renton WA or Portland OR)
Must reside in either WA or OR
WHO WE NEED
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:

• Experience with quality programs in the Medicare Advantage Line of Business
• Understanding of Medicare Advantage Model and Value-Based Care
• Prior management experience is strongly preferred

Normally to be proficient in the competencies listed above
Program Director, Medicare Provider Enablement would have:

• 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.

YOUR ROLE:

• 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.
• Represent 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
• SWAN, provider performance tools, MA provider facing vendor engagements
• 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

WHAT YOU BRING:

• 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

The expected target hiring range for the Program Director, Medicare Provider Enablement is $118k - $160k 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 $110.5k Low Range/ 138.5k MRP / $180.5k High Range.
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
• paid time off varying by role and tenure in addition to 10 company holidays
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
• one-time furniture and equipment allowance for employees working from home
• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free 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 CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.