Head of Medicare Performance Hub
Core
Lead the Medicare Performance Hub to drive performance improvement in Star Ratings, Risk Adjustment, and Medical Cost Management for Medicare Advantage plans.
Role type
Senior Director, Program Leadership & Strategy
Builds
Contract-level performance intelligence infrastructure, dashboards, and consultative support frameworks for plans.
Domain
US Healthcare / Medicare Advantage / Managed Care
Deliverable
dashboards & analysis
Required skills
Medicare Advantage program management, CMS Star Ratings expertise, Risk Adjustment/HCC coding accuracy, Medical Cost Management, multi-stakeholder management, data strategy, vendor management, governance framework design.
Preferred skills
MS in Health Administration, Public Health, or Business Administration.
Technologies
VRDC, NDW, EMR, clearinghouses, Health Information Exchanges, Parts C and D claims data, RAF files.
Responsibilities
Establish governance and accountability structures for plan performance; monitor real-time performance and identify gaps; deliver actionable member-level insights via dashboards; manage analytics platform vendors; lead Stars, Risk Adjustment, and Medical Cost Management analytics; engage with Plan CEOs and leadership; define escalation frameworks and corrective action plans.
Seniority
Senior Director, strategic leadership & operational oversight
