DIRECTOR, MEDICARE ADVANTAGE

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary of the position

The Program Director is responsible for the mechanical and financial integrity of our Medicare Advantage (MA) line of business. This role focuses on the back-end systems that drive the program: the annual bid process, Star ratings, risk adjustment data flow, and the accuracy of our clinical documentation. You will ensure our data is audit-proof and that our financial performance matches our strategic goals, while also identifying the opportunities we need to grow our market share.

Essential Duties

1. The MA Bid: Direct the cross-functional effort to complete and submit the annual bids.

2. Risk Adjustment Operations: You will be responsible for the accuracy of our coding data and ensure that every diagnosis is backed by clinical evidence in the record.

3. Data & Incentive Oversight: Manage the quantification and processing of provider incentive payments. You will oversee specialists analyzing data extracts to ensure accurate, timely payouts.

4. Audit Readiness: Maintain a continuous state of audit readiness for RADV and other federal reviews. You are the final check on the integrity of our clinical data repositories.

5. Star Ratings Support: Manage the operational side of quality metrics, ensuring the data systems for closing HEDIS and CAHPS gaps are functioning correctly.

6. Regulatory Compliance: Monitor and implement all CMS regulatory changes to ensure the MA line remains in total compliance with federal law.

Job Duties

• Maintains punctual, regular and predictable attendance.
• Works collaboratively with the Director of Equity & Tribal Partnerships on quality measures.
• Respectfully takes direction from leadership.
• Meets all required training including those listed in Relias Learning Module System (LMS).
• Performs other duties as assigned.

On Call Responsibilities

This position does not have any on-call responsibilities.

Supervisory Responsibilities

This position does not have any supervisory responsibilities.

Job Requirements

• MA Leadership: Significant experience leading the operational side of a Medicare Advantage Plan.
• Coding and Star Mastery: Expert knowledge of the CMS-HCC risk adjustment model and the Stars program.
• Financial Oversight: Proven ability to manage a budget and oversee complex financial data reconciliations.
• Data Management: Comfort working with large-scale data extracts and translating them into actionable operational plans.

Core Competencies

• Operational Precision: A focus on accuracy, from the June bid submission and revenue reconciliation down to the last cent of a provider incentive payment.
• System Thinking: The ability to trace how a regulatory or coding shift at the federal level translates into a direct financial impact on our local operations and the communities we serve.
• Urgency: A track record of meeting strict federal deadlines while maintaining high standards for data integrity.

Qualifications

• Bachelor’s degree in Health Administration, Business Administration, Public Health, or related field (Master’s degree preferred)
• 7–10+ years of experience in healthcare administration, with significant experience in Medicare Advantage
• Strong knowledge of CMS regulations, risk adjustment, and value-based care models
• Experience with healthcare analytics, quality improvement, and financial management

Experience

MA Leadership: Significant experience leading the operational side of a Medicare Advantage Plan.

Certificates, Licenses, and/or Registrations

Valid Oregon Driver’s License and vehicle insurance.

Technical Skills

Familiarity with the Healthcare industry.

Exceptional writing, editing, and proofreading skills.

Excellent organization and time-management skills.

Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).

Knowledge of and compliance with HIPAA regulations.

Knowledge of project management and/or change management.

Interpersonal Skills

Trust: Promotes honesty, transparency, and diligence. Approaches leadership with mindset of “power with” rather than “power over” and regularly includes others in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare Health.

Innovation: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commits to solving unresolved issues in an effort to collaborate and model problem solving. Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.

Relationships: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are lines of difference. Identifies and intervenes in problematic dynamics. Listens closely to understand needs or concerns and takes steps based on that input. Gets back to people in a timely manner. Takes pride in providing clear and helpful information.

Voice: Brings a clear vision and recognizes the value of divergent perspectives. Provides equity-centered conflict transformation support, interventions, and training in the team and across departments. Commits to and understands concepts of equity, belonging, and inclusion in the workplace. Effectively works and collaborates across differences. A working knowledge and understanding of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential duties.

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand, walk and reach with hands and arms. The noise level in the work environment is usually moderate.

The employee must be able to work onsite for all scheduled shifts.

The employee must be able to travel (locally, occasionally, as needed.)