A

agilon health

Value-based primary care platform for seniors

Director of Value Based Care Regulatory Compliance

Full-Time
No salary listed
Senior, Expert
Bachelor's, Master's
Remote in USA
Remote
Risk & ComplianceRegulatory Compliance & Ethics

About the job

Requirements
  • A bachelor’s degree in healthcare, business, or a related field is required.
  • Seven or more years of healthcare compliance experience, with significant focus on risk adjustment, regulatory affairs, or managed care compliance.
  • Five or more years of compliance auditing and monitoring experience, including audit program management and team oversight.
  • Five or more years of supervisory experience managing compliance professionals.
  • Substantial experience with CMS program requirements across Medicare Advantage risk adjustment and ACO programs.
  • Deep knowledge of OIG compliance requirements for managed care organizations, first-tier, downstream, and related entities, and ACO 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 OIG guidance and updates.
  • Capability to prepare and deliver board- and senior-leadership-level compliance metrics and reports.
  • Knowledge of value-based care, Medicare Advantage, fraud and abuse laws, and ACO REACH and MSSP programs.
  • Strong written and verbal communication skills to advise 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.
Responsibilities
  • 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 OIG high-risk condition monitoring.
  • Ensure risk adjustment program activities are clinically grounded, well documented, and audit ready in alignment with CMS and OIG 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 OIG 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, OIG, and fraud and abuse requirements.
  • Lead regulatory change management by tracking CMS guidance, OIG 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 OIG actions, and translate findings into actionable compliance guidance.
  • Maintain current knowledge of OIG 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.
Desired Qualifications
  • A master’s degree.
  • Certified in Healthcare Compliance certification; Certified Professional Coder or an equivalent risk adjustment coding credential is a plus.
  • Experience at a health plan, health system, provider group, or ACO.
  • Background in managed care operations, risk-based contracting, or Medicare Advantage compliance.
  • Familiarity with contract lifecycle management, matter management, or legal operations platforms.

About the company

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

Get referred to agilon health

See people who can refer or advise you

Simplify Jobs

Simplify's Take

What believers are saying

  • Q2 2026 revenue hit $1.49 billion, beating estimates and up 7%.
  • On September 30, 2026, Jackson Clinic expanded into Senior Health Connect ACO.
  • Springfield Clinic and Family Practice Center expanded ACO partnerships in September 2026.

What critics are saying

  • Total members fell to 549,000 in Q2 2026, signaling contracting market share.
  • August 1, 2026 CTO Girish Venkatachaliah's termination signals continued leadership churn.
  • CMS v28 risk-score normalization can erase agilon's 2026 margin recovery and liquidity runway.

What makes agilon health unique

  • agilon's Senior Health Connect ACO expands physician-led Medicare care without forcing clinic ownership.
  • Tim O'Rourke, appointed CEO May 7, 2026, prioritizes profitable growth over expansion.
  • agilon's 2,300 PCP network and AI-enabled data pipeline drive care-gap identification.

Help us improve and share your feedback! Did you find this helpful?

Benefits

Remote Work Options

Growth & Insights and Company News

Headcount

6 month growth

0%

1 year growth

0%

2 year growth

1%
BioPharma Watch
Sep 30th, 2026
agilon health and The Jackson Clinic advance their partnership through Senior Health Connect ACO.

agilon health and The Jackson Clinic advance their partnership through Senior Health Connect ACO. Key Takeaway: Agilon Health has expanded its partnership with The Jackson Clinic by integrating it into its Senior Health Connect Accountable Care Organizations (ACOs). This collaboration is expected to enhance healthcare delivery by leveraging The Jackson Clinic's extensive network of over 130 providers across various specialties. The partnership aims to empower physicians and improve patient outcomes in the community. Market sentiment Analysis. Positive factors. * Expansion of partnership enhances healthcare services. * The Jackson Clinic is a large and reputable organization. * Collaboration aims to empower physicians and improve patient care. WESTERVILLE, OH- agilon health (NYSE: AGL), the trusted partner empowering physicians to transform health care in its communities, today announced the expansion of its partnership with The Jackson Clinic, which will join one of agilon's Senior Health Connect Accountable Care Organizations (ACOs). The Jackson Clinic, one of Tennessee's largest independent physician organizations, includes more than 130 providers representing 24 specialties and subspecialties at 13 locations serving nine counties in the Jackson area. In 2022, the clinic began a long-term partnership with agilon to transition to a full-risk, value-based care model currently supporting approximately 8,000 senior Medicare Advantage patients. Now, The Jackson Clinic is joining agilon's Senior Health Connect ACO and is expected to help reach approximately 9,000 more Traditional Medicare beneficiaries across the communities it serves. The ACO participates in the Medicare Shared Savings Program (MSSP) and is expected to provide The Jackson Clinic with additional support to deliver more coordinated, personalized, patient-centered care focused on prevention, earlier intervention and improving outcomes while reducing unnecessary healthcare spending. agilon brings extensive experience supporting physicians through accountable care models. Since 2021, agilon's ACOs have generated more than $510 million in gross savings, including $125 million in savings to the Medicare Trust Fund, demonstrating the ability to improve outcomes while reducing costs. In 2024, the most recent year for which quality data is available, agilon's ACOs achieved an average quality score of 96%. Four of them earned perfect quality scores, and five were recognized as high performers for achieving exceptional results across all quality measures. "We are honored to enter this next phase of our partnership with The Jackson Clinic through Senior Health Connect ACO and continue our shared work to help physicians improve care for seniors," said Tim O'Rourke, chief executive officer of agilon health. "Accountable care is designed to help physicians look beyond a single visit and fully understand each patient's needs. Together, we can place greater emphasis on prevention, earlier intervention and effective chronic disease management to improve care quality, health outcomes and the patient experience, making a meaningful difference for people and communities across Tennessee." Founded in 2016, agilon partners with more than 30 physician groups and health systems to help them succeed in full-risk, value-based care for Medicare Advantage and fee-for-service innovation models. Through its next-generation technology and AI-enabled platforms, agilon transforms data from across the healthcare ecosystem into actionable insights that help physicians anticipate patient needs, intervene earlier and close care gaps. Specialized clinical pathways for chronic conditions such as heart failure, chronic obstructive pulmonary disease (COPD) and dementia further equip physicians to address complex patient needs and deliver more proactive, coordinated care at scale. "We are deeply connected to the patients and communities we serve, and joining Senior Health Connect ACO will help us provide more personalized care for Medicare patients while preserving the local, physician-led approach that defines The Jackson Clinic," said Nancy Utley, MD, chief quality officer at The Jackson Clinic. "With agilon's technology, insights and operational support, we can identify patients' needs earlier, help patients manage chronic conditions more effectively and make care easier to navigate. Just as importantly, care decisions remain between patients and the physicians who know them best." Building on a strong track record in ACO models, agilon health is well positioned to extend that momentum alongside its physician partners as accountable care evolves. The company's demonstrated success in driving quality outcomes and generating shared savings under ACO models provides a proven foundation as participating ACOs look to the future. With its long-term care model, deep primary care relationships and infrastructure built for value-based performance, agilon and its ACO partners are poised to capture significant opportunities for continued growth and strong performance across ACO models. This continuity reflects agilon's enduring commitment to helping community physicians thrive in accountable care and improve outcomes for the seniors they serve. About The Jackson Clinic. The Jackson Clinic is one of Tennessee's largest independent physician organizations which brings together the knowledge of more than 130 providers in 24 specialties and subspecialties, providing care to patients at 13 locations across nine counties in the Jackson area. The Jackson Clinic medical staff has privileges at hospitals throughout West Tennessee. Their physicians are supported by state-of-the-art technology in diagnostic testing departments, which include: Laboratory, Radiology (Ultrasound, CAT Scan, Dexascan, Bone Densitometry, Nuclear Medicine, Magnetic Resonance Imaging, and Mammography), Stereotactic Biopsy, Pulmonary Function Analysis, Arterial Blood Gases, Electrocardiography and Vascular Ultrasound. The clinic's mission is to enhance the lives of West Tennesseans by healing individual patients and promoting wellness for all through a collaborative affordable, and comprehensive healthcare system. Visitjacksonclinic.comto learn more or connect with BiopharmaWatch onFacebook,InstagramandYouTube. About agilon health. agilon health is the trusted partner empowering physicians to transform health care in its communities. Through its partnerships and purpose-built platform, agilon is accelerating at scale how physician groups and health systems transition to a value-based Total Care Model for their senior patients. agilon provides the technology, people, capital, process and access to a peer network of approximately 2,300 primary care physicians (PCPs) that allow its physician partners to maintain their independence and focus on the total health of their most vulnerable patients. Together, agilon and its physician partners are creating the healthcare system BiopharmaWatch need - one built on the value of care, not the volume of fees. The result: healthier communities and empowered doctors. agilon is the trusted partner in approximately 30 communities and is here to help more of its nation's leading physician groups and health systems have a sustained, thriving future. For more information, visit agilonhealth.com and connect with BiopharmaWatch on LinkedIn. The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. Forward looking statements. This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements generally relate to future events or its future financial or operating performance and may be identified by the use of words such as "may," "will," "expect," "believe," "intend," "anticipate," "seek," "target," "plan," "estimate," "potential," "could," "would," "should," and similar expressions and the negatives of those terms. Examples of forward-looking statements include, among other things: the benefits of our expanded partnership with The Jackson Clinic, our ACO model and our data uses with AI. These forward-looking statements are based on current expectations and assumptions and are subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Factors that may cause actual results to differ materially include those described under the heading "Risk Factors" in the Company's Annual Report on Form 10-K for the year ended December 31, 2025, and subsequent filings with the Securities and Exchange Commission. These documents contain and identify important factors that could cause actual results to differ materially from those contained in the Company's projections or forward-looking statements. Except as required by law, the Company undertakes no obligation to update any forward-looking statements, which speak only as of the date they are made. Contacts. Investor contacts. Media contact. The postagilon health and The Jackson Clinic advance their partnership through Senior Health Connect ACOappeared first onagilon health. Frequently asked questions. What is the purpose of the partnership between Agilon Health and Jackson Clinic? The partnership aims to enhance healthcare services through the Senior Health Connect ACO. How many providers are at The Jackson Clinic? The Jackson Clinic includes over 130 providers across 24 specialties. Where is The Jackson Clinic located? The Jackson Clinic operates at 13 locations in Tennessee. What is an Accountable Care organization (ACO)? An ACO is a group of healthcare providers that work together to improve patient care.

BioPharma Watch
Aug 27th, 2026
agilon health announces revised presentation time at the 2026 Jefferies Healthcare Services and Technology Conference.

agilon health announces revised presentation time at the 2026 Jefferies Healthcare Services and Technology Conference. Key Takeaway: Agilon Health has announced a change in the timing of its presentation at the 2026 Jefferies Healthcare Services and Technology Conference. The management team will now participate in a fireside chat scheduled for 4:00 PM ET on September 14, 2026. Investors can access the presentation through a webcast. Market sentiment analysis. Positive factors. * Agilon Health is actively engaging with investors. * The company is participating in a significant healthcare conference. * The revised presentation time allows for broader audience access. WESTERVILLE, Ohio-(BUSINESS WIRE)-agilon health, inc. (NYSE: AGL), the trusted partner empowering physicians to transform health care in its communities, today announced that its management team will now participate in a fireside chat at the 2026 Jefferies Healthcare Services and Technology Conference at 4:00pm ET on Monday, September 14, 2026. Interested investors and other parties may listen to a simultaneous webcast of the presentation by visiting the "Events & Presentations" section o Frequently asked questions. What is the new presentation time for Agilon Health? The new presentation time is 4:00 PM ET on September 14, 2026. Where can I listen to the Agilon Health presentation? The presentation can be accessed via a webcast in the 'Events & Presentations' section. What type of event is Agilon Health participating in? Agilon Health is participating in the 2026 Jefferies Healthcare Services and Technology Conference.

Yahoo Finance
Aug 14th, 2026
Agilon Health beats Q2 estimates with $1.49B revenue and $69.57M EBITDA

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.

Yahoo Finance
Aug 6th, 2026
Agilon Health posts $70M Q2 profit, raises 2026 outlook to $485M medical margin

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.

Yahoo Finance
Aug 5th, 2026
Agilon Health beats Q2 revenue expectations with $1.49B, raises full-year guidance to $5.82B

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.