Job Details

AllCare Health Headquarters, Grants Pass, OR, US9 days ago Requisition ID: 1194Salary Range: $120,000.00 To $150,000.00 AnnuallyJob DescriptionMedicare Advantage Program Director at AllCare Health with the Marketing Department - in Grants Pass, Oregon.AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.Summary of the PositionThis role offers significant growth potential as the Medicare population continues to expand. As a key part of this evolution, you will help build a robust data lake and repository designed to centralize member electronic medical records, supporting critical internal processes and the rollout of AI‑driven audits and data set analysis. Success in this position requires a sharp analytical mindset. You will be responsible for ensuring the business line stays aligned with bid and budget targets while driving performance in Star ratings and risk adjustment gap closures.ResponsibilitiesDirect the cross‑functional effort to complete and submit the annual bids.Ensure the accuracy of our coding data and that every diagnosis is backed by clinical evidence in the record.Manage the quantification and processing of provider incentive payments and oversee specialists analyzing data extracts to ensure accurate, timely payouts.Maintain continuous audit readiness for RADV and other federal reviews; perform final checks on the integrity of clinical data repositories.Manage the operational side of quality metrics, ensuring the data systems for closing HEDIS and CAHPS gaps are functioning correctly.Monitor and implement all CMS regulatory changes to keep the MA line in full compliance with federal law.Job DutiesMaintain punctual, regular, and predictable attendance.Work collaboratively with the Director of Equity & Tribal Partnerships on quality measures.Respectfully take direction from leadership.Meet all required training including those listed in Relias Learning Module System (LMS).Perform other duties as assigned.Job RequirementsMA 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 CompetenciesOperational 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: Ability to trace how a regulatory or coding shift at the federal level translates into a direct financial impact on local operations and the communities served.Urgency: Track record of meeting strict federal deadlines while maintaining high standards for data integrity.Qualifications7–10+ 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.EducationBachelor's degree in Health Administration, Business Administration, Public Health, or related field (Master's degree preferred).ExperienceMA Leadership: Significant experience leading the operational side of a Medicare Advantage Plan.Bilingual SkillsBeing bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care. We strongly encourage you to apply if you are bilingual.Certificates, Licenses, and/or RegistrationsValid Oregon Driver's License and vehicle insurance.Technical SkillsFamiliarity 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 SkillsTrust: Promotes honesty, transparency, and diligence. Approaches leadership with a 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 and collaborates to model problem‑solving. Proactively develops solutions to challenges.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. Has a working knowledge of how implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.Physical Demands & Work EnvironmentThe 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.EEO StatementAll qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.Schedule: Monday‑Friday 8:00AM-5:00PM with a 1 hour unpaid lunch and two 15 minute paid breaks – 40 Hours#J-18808-Ljbffr