Program Manager - Risk Adjustment & Stars
$84k - $120k+ Annual bonus
Senior
Bachelor's, Master's
Remote in USA+2 moreMore locations: California, USA | Denver, CO, USA
RemoteRemote work is supported in the listed locations; role requires travel to meetings.
Project & Program ManagementProgram Management
About the job
Requirements
- Bachelor's degree in health informatics, data analytics, healthcare administration, business, or a related field; a master's degree is preferred.
- Five to seven years of experience in Medicare Advantage risk adjustment and/or Star Ratings or quality improvement, ideally in a value-based care setting.
- Working knowledge of CMS HCC risk adjustment models, RAF score methodology, EDS submission processes, and Star Ratings measure specifications.
- Ability to work effectively with technical teams and operational/business stakeholders, translating between them.
- Program/project management experience managing cross-functional initiatives involving technical and operational workstreams.
- Working proficiency in Excel.
- Strong written and verbal communication skills to translate technical and regulatory details for operational and executive audiences.
- 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 concurrent demands in a high-stress environment, organize, coordinate, set priorities, and meet deadlines.
- A HIPAA-compliant home office for remote or telecommuting work, as required by company policies and procedures.
Responsibilities
- Own the annual risk adjustment and Stars improvement program cycle, coordinating technical teams and operational/business stakeholders across prospective and retrospective programs, visit-based campaigns, and gap-closure workflows.
- Build and manage program timelines and throughput, and report progress to company leadership and health plan partners in clear, business-friendly terms.
- Lead cross-functional workgroups spanning coding/HCC teams, clinical quality, IT, and analytics, ensuring technical work aligns with operational priorities.
- Manage program-level documentation and requirements, translating between technical specifications and operational plans.
- Serve as liaison between coding/data teams and operational stakeholders on HCC capture workflows, chart-review pipelines, and gap identification, ensuring both sides understand priorities and constraints.
- Manage vendor relationships, coordinating technical file exchange and integration needs with operational timelines and expectations.
- Monitor RAF score trends and performance results, work with analytics teams to interpret findings, and translate them into operational action plans.
- Coordinate risk-adjustment data submission accuracy and reconciliation (EDS), connecting technical issue resolution with business and health plan deadlines.
- Track HCC model version transitions, including CMS-HCC V24/V28, and communicate their operational and financial impact to leadership and business teams.
- Coordinate Star Ratings strategy across HEDIS, CAHPS, HOS, and medication-adherence measures, connecting technical measure logic with operational execution.
- Partner with analytics teams to maintain measure-level performance tracking and cut-point modeling, translating results into operational priorities and gap-closure plans.
- Serve as a point of contact with health plan Stars/quality teams, bridging technical data-exchange requirements with operational and contractual needs.
- Partner with analytics and data teams to define KPIs and dashboards for RAF accuracy, coding gap-closure rates, and Star measure performance, ensuring outputs are operationally useful.
- Translate CMS methodology updates, including HCC model version changes, Star Ratings technical notes, and measure-weighting changes, for technical teams as specifications and operational teams as business impact.
- Identify and escalate data-integrity issues across claims, EHR, and supplemental data feeds, coordinating resolution between technical and operational owners.
- Present performance results and program recommendations to executive leadership and payer partners.
- Ensure program activities comply with CMS regulations, ICD-10-CM coding guidelines, and company compliance policies.
- Support RADV audit readiness and health plan data-validation requests, coordinating technical data retrieval with operational/compliance response management.
Desired Qualifications
- Certified Risk Adjustment Coder (CRC) credential.
- Experience with value-based care, ACOs, or delegated risk arrangements.
- Familiarity with multiple health plan Stars/quality programs and data-exchange requirements.
- PMP or similar certification.
- Familiarity with SQL, Tableau, Power BI, or similar tools.
About the company
Alpine Physician Partners helps physicians who serve seniors and vulnerable populations deliver better care while controlling costs. It offers a full set of services, technology, and skilled personnel to support access, quality, and efficiency in care. The company combines direct physician–patient encounters with interdisciplinary collaboration, all backed by a strong administrative framework and physician-designed technology that streamlines practice management and clinical operations. Revenue comes from selling these tailored solutions to physician partners who participate in value-based care arrangements. Compared with others, Alpine emphasizes a tightly integrated mix of human resources, technology designed by physicians, and a focus on value-based care for seniors and vulnerable groups. The goal is to improve care quality and access for high-need populations while making physician practices more efficient and financially sustainable.
Company Size
N/A
Company Stage
N/A
Total Funding
N/A
Headquarters
N/A
Founded
N/A
Simplify's Take
What believers are saying
- LinkedIn showed 107 employees on July 4, 2026, while jobs expanded in Colorado, Texas.
- 2026 postings advertised J1 and H-1B sponsorship, widening physician recruiting.
- California's 2026 Medi-Medi plan list still includes Alpine-branded Medicare Advantage options.
What critics are saying
- Only 107 employees on July 4, 2026 leaves Alpine outmatched by national risk-bearing groups.
- If Ambience adoption fades, Alpine loses a core retention and recruiting story quickly.
- A Medicare Advantage coding shock could erase margins and force practice sales within 2027.
What makes Alpine Physician Partners unique
- Alpine's October 3, 2026 site spotlights senior-focused value-based primary care and MSO support.
- Its Ambience AI rollout cut charting from 4.7 hours to 1.2 daily.
- Alpine pairs interdisciplinary teams with home urgent care, virtual specialists, and geriatrics clinics.
Help us improve and share your feedback! Did you find this helpful?
Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Company Match
- Paid Vacation
- Paid Sick Leave
- Hybrid Work Options