Program Director Medicare Quality Incentive Program

PROGRAM DIRECTOR MEDICARE QUALITY INCENTIVE PROGRAM (HEALTHCARE)

Work from home (telecommute) within Oregon, Washington, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s Medicare Quality Team is living our mission to make health care easier and lives better. 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 – all in service of making our members’ health journeys easier.  

If you're a motivated and experienced People Leader with Medicare experience looking to make a difference in the healthcare industry, apply for this exciting opportunity today!
 

What You Bring to Cambia: 

Preferred Key Experience:

• This person must be highly strategic around Provider engagement

• Needs to ensure we meet our Provider performance targets and work with The Provider Engagement Director in Network to develop engagement plans

• Needs operational skills to oversight the provider incentive payment process

• MUST BE a people leader within a healthcare or Payer Health Plan environment.

Qualifications and Certifications:  

• 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.

Skills and Attributes (Not limited to):  

• 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  

What You Will Do at Cambia (Not limited to):   

• 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 

• 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 

The expected hiring range for The Program Director Medicare QIP is $130k–$166k, 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 $113k Low/ $142k MRP / $185k High

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. 
• Annual employer contribution to a health savings account.  
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. 
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). 
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). 
• Award-winning wellness programs that reward you for participation. 
• Employee Assistance Fund for those in need. 
• Commute and parking benefits. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.