Director, Medicare P&L Management

Job description

#LI-Hybrid - Program Leadership - Function as the leader and champion of the Medicare Stars Program, risk adjustment operations, and Medicare cost of care initiatives. - Collaborate with internal and external stakeholders to establish measure by measure targets for the 50+ clinical, experience and administrative measures in support of the overall contract-level Stars goal. - Develops targets for key operational metrics to drive improvement in risk score accuracy. Works with Finance to forecast risk scores for each contract, plan, and member segments. - Develops and evolves the programs operating model, leveraging and defining responsibilities for internal resources, vendors, the provider network, provider enablement entities, and external partners to drive performance. - Educates stakeholders, partners and vendors about Stars and Risk Adjustment program requirements and drive performance to meet expectations. - Define and implement processes for monitoring key operational performance metrics and establish processes for managing vendor relationships, monitoring vendor performance, and provider performance. - Maintains a deep understanding and educates stakeholders on CMS requirement...