Program Manager - Medicare Advantage; Hybrid

Resp & Qualifications

PURPOSE:

Drives Medicare Advantage Risk Adjustment performance through oversight of key operational processes, performance monitoring, analytics, and strategic initiatives. Identifies trends, opportunities, and performance gaps; develops and implements improvement strategies; and communicates results to stakeholders by translating operational performance into measurable business and financial outcomes. Collaborates across departments to support organizational objectives, improve risk-adjusted revenue, and enhance overall program effectiveness.

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a Care First location based on business needs and work activities/deliverables that week.

• Analyzes aggregate Medicare Advantage Risk Adjustment performance across the line of business, leveraging available reporting, operational metrics, and financial results to identify trends, risks, performance gaps, and improvement opportunities. Conducts detailed analyses to understand performance drivers and translates findings into actionable recommendations that support organizational objectives

• Monitors and reports on key performance indicators, including risk score performance, condition prevalence and coding trends, documentation quality, submission effectiveness, and revenue impact. Synthesizes complex data into clear, actionable insights and communicates business implications, opportunities, and risks to leadership and P&L stakeholders.

• Monitors and reports on key performance indicators, including risk score performance, coding capture, recapture rates, provider coding performance, documentation quality, submission effectiveness, and revenue impact. Synthesizes complex data into clear, actionable insights and communicates business implications, opportunities, and risks to leadership and P&L stakeholders.

• Partners with business, clinical, operational, financial, analytics, compliance, provider, and vendor stakeholders to investigate performance drivers, validate findings, and support implementation of improvement initiatives. Influences decision-making by connecting analytical findings to measurable business and financial outcomes and monitoring results over time.

Leads a team utilizing a matrix management system

Education Level: Bachelor's Degree in Business Management or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience:

8 years project management or program management experience

• Master's Degree
• Project Management Professional Certification (PMP)
• 8+ years in managing risk adjustment programs and provider incentives
• 5+ years in value-based care for Medicare Advantage
• 5+ Provider Engagement or Provider Enablement in Medicare markets

• Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.
• Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.
• Ability to translate business needs as it relates to technology, systems, and vendor platforms.
• Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
• Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.
• Knowledge and discipline of Process Improvement.
• Use of Microsoft Applications.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

• Certified Project Management Professional (PMP)-PMI

$106,632 - $211,783

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being…