Program Manager, Risk Adjustment – Stars

🔥 15 hours ago

🏄 California, Colorado – Remote

🏄 California – Remote ⛰️ Colorado – Remote

💵 $84k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

👻 Ghost score 0%

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Alpine Physician Partners

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Alpine Physician Partners is a company committed to restoring the joy of medical practice by empowering physicians to provide world-class care, particularly for seniors and vulnerable populations. The company offers a robust blend of services, technology, and human capital resources tailored to address the challenges of modern healthcare, such as regulatory burdens and consumer demands. Alpine supports physicians through a network of peers and an innovative care delivery model that emphasizes interdisciplinary collaboration and technology-enabled solutions like machine learning and predictive analytics. With a focus on integrated, coordinated care, especially within the Medicare and Medicare Advantage population, Alpine aims to transform healthcare delivery and enhance patient outcomes.

📋 Description

• Own the annual risk adjustment and Stars improvement program cycle across prospective and retrospective programs, visit-based campaigns, and gap closure workflows • Build and manage program timelines and throughput; report progress to Alpine leadership and health plan partners • Lead cross-functional workgroups spanning coding/HCC, clinical quality, IT, and analytics • Manage program documentation and requirements, translating technical specifications into operational plans • Liaise between coding/data teams and operational stakeholders on HCC capture, chart review, and gap identification workflows • Manage vendor relationships and coordinate technical file exchange and integration needs • Monitor RAF score trends and performance results and translate findings into operational action plans • Coordinate risk adjustment data submission accuracy and EDS reconciliation • Track HCC model version transitions and communicate operational and financial impacts • Coordinate Star Ratings strategy across HEDIS, CAHPS, HOS, and medication adherence measures • Partner with analytics teams on performance tracking, cut-point modeling, KPIs, and dashboards • Serve as a point of contact with health plan Stars/quality teams • Identify and escalate data integrity issues across claims, EHR, and supplemental data feeds • Present performance results and program recommendations to executive leadership and payer partners • Ensure compliance with CMS regulations, ICD-10-CM coding guidelines, and company policies • Support RADV audit readiness and health plan data validation requests

🎯 Requirements

• Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field required • 5 to 7 years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement • Working knowledge of CMS HCC risk adjustment models, RAF score methodology, EDS submission processes, and Star Ratings measure specifications • Demonstrated ability to work with technical teams and operational/business stakeholders, translating between the two • Proven program/project management experience managing cross-functional technical and operational initiatives • Working proficiency in Excel required • Strong written and verbal communication skills • Strong relationship management and cross-functional collaboration skills • Ability to interpret data and technical findings and turn them into operational plans • Ability to adapt to evolving CMS methodology and health plan requirements • Ability to travel to meetings • Ability to handle multiple demands concurrently in a high-stress environment, organize, coordinate, set priorities, and meet deadlines • HIPAA-compliant home office for remote or telecommuting positions • CRC credential, value-based care/ACO/delegated risk experience, familiarity with multiple health plan Stars/quality programs, PMP or similar certification, and SQL/Tableau/Power BI familiarity preferred or a plus

🏖️ Benefits

• Eligible for annual bonus based on individual and/or company performance • Medical insurance • Dental insurance • Vision insurance • 401(k) • Paid time off (PTO) • Employee Assistance Program (EAP) • HIPAA-compliant home office for remote or telecommuting positions