Full-Time
Director of Value Based Care Regulatory Compliance
agilon health
501-1,000 employees
Value-based primary care platform for seniors
Compensation Overview
$153k - $191.3k/yr
Ohio, USA
Remote
Bachelor's, Master's
 Legal & Compliance (1) |
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- A bachelor's degree in healthcare, business, or a related field.
- At least 7 years of healthcare compliance experience, with significant focus on risk adjustment, regulatory affairs, or managed care compliance.
- At least 5 years of compliance auditing and monitoring experience, including audit program management and team oversight.
- At least 5 years of supervisory experience managing compliance professionals.
- Substantial experience with CMS program requirements across Medicare Advantage risk adjustment and ACO programs.
- Deep knowledge of Office of Inspector General compliance requirements for managed care organizations, first-tier, downstream, and related entities, and accountable care organization participants, including audit expectations and high-risk condition monitoring.
- Expertise with risk adjustment coding, RADV audit processes, and supplemental data validation.
- Skill in regulatory change management, including monitoring, analyzing, and communicating CMS and Office of Inspector General guidance and updates.
- Ability to prepare and deliver compliance metrics and reports for boards and senior leadership.
- Knowledge of value-based care, Medicare Advantage, fraud and abuse laws, and ACO REACH and MSSP programs.
- Strong written and verbal communication skills for advising internal clients and external partners.
- Ability to apply legal reasoning and sound judgment to complex, novel regulatory and transactional problems with incomplete information.
- Ability to create and maintain documents using Microsoft Office, including Word, Excel, Outlook, and PowerPoint.
- Lead the markets compliance program for Medicare Advantage and ACO programs, including ACO LEAD, ACO REACH, and MSSP regulatory and operational requirements, ensuring compliant program design and execution.
- Develop and implement policies, procedures, and training specific to markets compliance program operations.
- Serve as the primary compliance liaison to physician partner groups, medical directors, and market leadership to drive compliance awareness, education, and accountability.
- Oversee coordination with health plans and downstream partners on compliance program requirements, audit activity, and corrective action.
- Monitor and communicate CMS risk adjustment policy developments, enforcement trends, and program-specific requirements across Medicare Advantage and ACO programs.
- Identify compliance gaps across markets and enterprise operations and communicate risks and remediation recommendations to the Chief Compliance Officer, senior leadership, and impacted business areas.
- Collaborate with Legal to confirm ACO compliance obligations are met across applicable CMS direct contracting programs, including ACO REACH, MSSP, and ACO LEAD.
- Oversee risk adjustment compliance, including regulatory alignment for the Pre-Member Record Review and Burden of Illness program, coding audit protocols, and Office of Inspector General high-risk condition monitoring.
- Ensure risk adjustment program activities are clinically grounded, well-documented, and audit-ready in alignment with CMS and Office of Inspector General expectations.
- Provide regulatory compliance support for clinical pathways, partnering with the Clinical team to ensure program design and execution are compliant, defensible, and aligned with CMS and Office of Inspector General requirements.
- Collaborate with Clinical, Legal, and Compliance leadership to identify and mitigate regulatory risk in clinical program design and implementation.
- Collaborate with Legal to assess the compliance and regulatory standing of clinical pathway vendors, including review of vendor arrangements, program design, and adherence to applicable CMS, Office of Inspector General, and fraud and abuse requirements.
- Lead regulatory change management by tracking CMS guidance, Office of Inspector General updates, and federal and state regulatory developments affecting managed care, ACO programs, and value-based care.
- Assess regulatory and enforcement developments, including False Claims Act settlements and Department of Justice and Office of Inspector General actions, and translate findings into actionable compliance guidance.
- Maintain current knowledge of Office of Inspector General compliance requirements for managed care organizations, first-tier, downstream, and related entities, health plans, and ACO participants.
- Develop and present compliance metrics, dashboards, and reports for senior leadership and the internal Compliance Committee.
- A master's degree.
- CHC certification.
- Experience at a health plan, health system, provider group, or ACO.
- A background in managed care operations, risk-based contracting, or Medicare Advantage compliance.
- Familiarity with contract lifecycle management, matter management, or legal operations platforms.
agilon health builds a Medicare-focused value-based primary care network. It partners with independent primary care physicians to deliver senior care through a unified operating platform that connects payors, physicians, and patients. The platform combines people, processes, and technology to help physician partners close gaps in care, integrate with payors, and grow their practices, while enabling predictable margins and improved patient experience. Unlike models that push physicians to join large owned practices, agilon health keeps clinicians independent and supports them with coordinated care delivery and financial certainty. The company’s goal is to improve health outcomes for seniors by expanding access to quality primary care, aligning incentives across physicians, payors, and patients, and driving value-based care at scale.
Company Size
501-1,000
Company Stage
IPO
Headquarters
Long Beach, California
Founded
2016
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Simplify's Take
What believers are saying
- Q2 2026 revenue hit $1.49 billion, beating estimates and lifting guidance to $5.82 billion.
- Medical margin reached $197 million, while adjusted EBITDA rose to $70 million.
- Membership rose to 549,000 live members, reversing Q1's 426,000 trough.
What critics are saying
- The 2025 securities class action still hangs over agilon's accounting and disclosure credibility.
- Medicare Advantage membership fell to 437,000 from 498,000, shrinking fee-bearing lives.
- If cost trends reverse, the model returns to losses and investor confidence collapses.
What makes agilon health unique
- Tim O'Rourke's May 2026 arrival from Humana deepens payer and Medicare Advantage expertise.
- Agilon's physician-owned partnership model keeps independent primary care groups in local markets.
- Its data pipeline spans over 80% of payers, sharpening risk adjustment and care management.
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Benefits
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Growth & Insights and Company News
6 month growth
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↑ 1%Agilon Health reported second-quarter results that significantly beat revenue and profitability expectations, though shares fell following the announcement. Revenue reached $1.49 billion, beating analyst estimates of $1.45 billion, whilst adjusted earnings per share hit $2.15 versus the $0.27 forecast. CEO Tim O'Rourke attributed the strong performance to operational improvements, including earlier identification of high-risk conditions and expanded clinical pathways, particularly in chronic heart failure management. The company's enhanced data pipeline and AI investments also contributed to better outcomes and reduced medical costs. The company raised its full-year revenue guidance to $5.82 billion at the midpoint, up from $5.74 billion. Customer numbers grew to 549,000 from 426,000 in the previous quarter. During the earnings call, analysts questioned the sustainability of improved margins and cost moderation trends, with management highlighting that over 80% of payers are now integrated into the enhanced data pipeline.
Agilon Health reported second-quarter revenue of approximately $1.5 billion, medical margin of $197 million, and adjusted EBITDA of $70 million, exceeding guidance and reversing prior-year losses of $53 million and $83 million respectively. The company raised its 2026 outlook to roughly $5.8 billion in revenue, $485 million in medical margin, and $85 million in adjusted EBITDA. The improvements were driven by stronger risk-adjustment revenue and favorable medical-cost trends, despite lower Medicare Advantage membership. Medicare Advantage membership stood at 437,000 at quarter-end, down from 498,000 a year earlier but up from 426,000 in the first quarter. CEO Tim O'Rourke emphasised operational consistency and clinical programmes for conditions including heart failure, COPD, and dementia, whilst prioritising growth in existing markets.
Healthcare services company Agilon Health reported second-quarter 2026 revenue of $1.49 billion, beating analyst estimates of $1.45 billion and representing 7.2% year-on-year growth. The company also exceeded expectations for GAAP profit, reporting $1.04 per share against analyst estimates of $0.01. Agilon raised its full-year revenue guidance to $5.82 billion at the midpoint, up from $5.74 billion previously. The company's adjusted EBITDA of $70 million significantly beat analyst estimates of $19.95 million. The platform provider for value-based care models reported 549,000 customers in the quarter, up from 426,000 in the previous quarter. Operating margin improved to 0.8%, compared with negative 8.3% in the same quarter last year.
Agilon Health (NYSE:AGL) releases earnings results, beats estimates by $0.92 EPS. August 5, 2026 Key points. * Agilon Health beat quarterly earnings expectations: The company reported $1.04 in EPS, exceeding the $0.12 consensus estimate by $0.92, while revenue reached $1.49 billion versus expectations of $1.45 billion. * Shares surged 12.4% to $106.55 following the earnings release, although the stock remains highly volatile, with a beta of 3.01 and a 52-week range of $7.48 to $133.04. * Analyst sentiment remains mixed despite several upgrades: Agilon has five Buy, six Hold, and three Sell ratings, producing a consensus rating of Hold and an average price target of $66.50. * MarketBeat previews the top five stocks to own by September 1st. Agilon Health (NYSE:AGL - Get Free Report) posted its quarterly earnings data on Wednesday. The company reported $1.04 earnings per share (EPS) for the quarter, topping analysts' consensus estimates of $0.12 by $0.92, FiscalAI reports. Agilon Health had a negative return on equity of 146.03% and a negative net margin of 6.09%.The business had revenue of $1.49 billion during the quarter, compared to the consensus estimate of $1.45 billion. Agilon Health stock up 12.4%. AGL stock traded up $11.77 during mid-day trading on Wednesday, reaching $106.55. The company had a trading volume of 1,112,918 shares, compared to its average volume of 354,822. The company has a market capitalization of $1.78 billion, a price-to-earnings ratio of -4.94 and a beta of 3.01. Agilon Health has a 52 week low of $7.48 and a 52 week high of $133.04. The stock has a 50 day simple moving average of $106.46 and a two-hundred day simple moving average of $54.68. The company has a debt-to-equity ratio of 0.08, a current ratio of 1.04 and a quick ratio of 1.04. Analyst ratings changes. A number of research firms have weighed in on AGL. Jefferies Financial Group raised Agilon Health from a "hold" rating to a "buy" rating and upped their price target for the stock from $27.50 to $48.00 in a research report on Thursday, May 7th. Deutsche Bank Aktiengesellschaft raised shares of Agilon Health from a "hold" rating to a "buy" rating and boosted their price objective for the stock from $33.00 to $49.00 in a research report on Thursday, May 7th. Wells Fargo & Company restated an "overweight" rating and set a $141.00 target price (up from $72.00) on shares of Agilon Health in a report on Monday, July 13th. JPMorgan Chase & Co. downgraded shares of Agilon Health from a "neutral" rating to an "underweight" rating and set a $21.00 target price for the company. in a research report on Monday, May 4th. Finally, Benchmark reissued a "buy" rating and set a $95.00 price target (up from $13.00) on shares of Agilon Health in a research report on Thursday, May 21st. Five research analysts have rated the stock with a Buy rating, six have issued a Hold rating and three have issued a Sell rating to the company's stock. According to data from MarketBeat.com, the stock currently has an average rating of "Hold" and a consensus price target of $66.50. Discover more Financial News Subscription Stock Profit Calculator Dividend Screener Tool Hedge funds weigh in on Agilon Health. Several hedge funds and other institutional investors have recently made changes to their positions in the company. CIBC Bancorp USA Inc. bought a new stake in Agilon Health during the third quarter worth $34,000. Tower Research Capital LLC TRC grew its position in shares of Agilon Health by 214.0% in the 2nd quarter. Tower Research Capital LLC TRC now owns 37,079 shares of the company's stock valued at $85,000 after acquiring an additional 25,270 shares during the period. Prudential Financial Inc. increased its stake in shares of Agilon Health by 70.7% during the 2nd quarter. Prudential Financial Inc. now owns 40,880 shares of the company's stock worth $94,000 after purchasing an additional 16,928 shares during the last quarter. LPL Financial LLC increased its stake in shares of Agilon Health by 213.4% during the 4th quarter. LPL Financial LLC now owns 44,055 shares of the company's stock worth $30,000 after purchasing an additional 30,000 shares during the last quarter. Finally, WINTON GROUP Ltd bought a new stake in shares of Agilon Health in the 2nd quarter valued at about $106,000. Agilon Health company profile. Agilon Health NYSE: AGL is a healthcare company that partners with independent primary care physicians to deliver value-based care for Medicare beneficiaries. Through risk-sharing arrangements, Agilon assumes financial responsibility for patient populations, enabling physicians to focus on preventive and proactive health management. The company provides the administrative, clinical and operational infrastructure needed to support comprehensive care delivery. Agilon's platform encompasses data analytics, care management, patient engagement tools and population health programs. This instant news alert was generated by narrative science technology and financial data from MarketBeat in order to provide readers with the fastest reporting and unbiased coverage. Please send any questions or comments about this story to [email protected]. Continue following MarketBeat Before you consider Agilon Health, you'll want to hear this. MarketBeat keeps track of Wall Street's top-rated and best performing research analysts and the stocks they recommend to their clients on a daily basis. MarketBeat has identified the five stocks that top analysts are quietly whispering to their clients to buy now before the broader market catches on... and Agilon Health wasn't on the list. 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Woodward, a designer and manufacturer of energy control products and optimisation solutions, has seen its share price rise 9.9% over the past month. The company has demonstrated strong fundamentals, with annual revenue growth of 13% over the past five years and expanding operating profits as it gained leverage on fixed costs. Share buybacks have further enhanced shareholder value, pushing annual earnings per share growth to 19.9%, outperforming revenue gains over the last two years. Meanwhile, two momentum stocks face challenges. Agilon health, which helps physicians transition to value-based care models for Medicare patients, trades at 102.6 times forward EV-to-EBITDA despite flat estimated sales and cash-burning tendencies. Prudential Financial has seen stagnant net premiums earned over five years and book value per share decline by 9% annually, whilst carrying a high net-debt-to-EBITDA ratio of 5 times.