Accountable Care Organization (ACO) Manager

American Telehealth LLC•Plainview, NY

4d•$80,000 - $100,000•Hybrid

About The Position

Seniority Healthcare is seeking an experienced, analytical, and results-driven full-time ACO Manager to oversee the organization's participation in value-based care programs, with a primary focus on the CMS ACO LEAD Model beginning in 2027. Seniority Healthcare provides primary care, behavioral health, chronic care management, and palliative care services to medically complex, high-risk geriatric patients in senior living communities and home-based settings. The ACO Manager will be responsible for optimizing financial and clinical performance through risk adjustment, patient attribution, quality reporting, utilization management, and Medicare program compliance. This individual will serve as the operational leader for ACO performance, working closely with clinical leadership, providers, care management, billing, and executive leadership to maximize shared savings opportunities while improving patient outcomes.

Requirements

Experienced, analytical, and results-driven
Must be located in-NJ, PA, DE, or NY
Experience with value-based care programs, with a primary focus on the CMS ACO LEAD Model
Experience in optimizing financial and clinical performance through risk adjustment, patient attribution, quality reporting, utilization management, and Medicare program compliance
Experience serving as an operational leader for ACO performance
Experience working closely with clinical leadership, providers, care management, billing, and executive leadership
Experience managing daily operations associated with ACO participation
Experience monitoring Medicare expenditures against established financial benchmarks
Experience analyzing monthly capitation payments, risk-adjusted revenue, utilization, and shared savings projections
Experience identifying opportunities to reduce unnecessary hospitalizations, emergency department utilization, and avoidable healthcare spending
Experience developing monthly financial and operational ACO performance dashboards
Experience forecasting annual ACO profitability and financial exposure
Experience coordinating with ACO partners regarding performance reports, financial reconciliation, and contractual obligations
Experience leading risk adjustment strategy
Experience monitoring patient risk scores, coding completeness, and documentation accuracy
Experience collaborating with providers to identify and appropriately document clinically supported chronic conditions
Experience coordinating annual comprehensive assessments and documentation reviews
Experience identifying gaps in risk adjustment documentation and ensuring timely correction
Experience developing provider education initiatives to improve coding accuracy and compliance
Experience tracking risk-score trends and the financial implications of risk adjustment
Experience managing ACO patient attribution, alignment, and enrollment processes
Experience identifying eligible Medicare beneficiaries
Experience reconciling attribution rosters with internal patient records
Experience monitoring additions, removals, eligibility changes, and beneficiary alignment
Experience collaborating with clinical and administrative teams to maximize appropriate ACO participation
Experience coordinating the onboarding of newly aligned patients and ensuring completion of required documentation
Experience developing and maintaining patient attribution tracking tools
Experience analyzing hospital admissions, readmissions, emergency department visits, skilled nursing utilization, and other high-cost services
Experience identifying patients at elevated risk for hospitalization
Experience coordinating with clinical operations to deploy targeted interventions
Experience collaborating with care management teams to support transitions of care
Experience monitoring post-acute utilization and opportunities to improve discharge planning
Experience evaluating utilization patterns
Experience developing actionable reports highlighting avoidable spending and opportunities for improvement
Experience overseeing ACO quality reporting requirements
Experience monitoring preventive care, chronic disease management, medication management, and other applicable quality measures
Experience collaborating with providers and clinical leadership to close care gaps
Experience establishing quality improvement initiatives and tracking outcomes
Experience ensuring data accuracy and timely submission of required quality information
Experience supporting provider education regarding ACO performance expectations
Experience developing and maintaining an ACO performance dashboard
Experience integrating information from claims, EHR, billing, care management, and ACO partner data sources
Experience producing weekly operational reports and monthly executive summaries
Experience identifying trends in patient spending, utilization, risk scores, quality metrics, and financial performance
Experience translating complex data into practical recommendations for clinical and executive leadership
Experience ensuring data integrity across reporting platforms
Experience maintaining working knowledge of CMS ACO LEAD requirements and applicable Medicare regulations
Experience coordinating compliance with program requirements, reporting deadlines, and beneficiary protections
Experience monitoring billing practices involving CCM, RPM, CoCM, and other care management services
Experience collaborating with billing and compliance teams to identify potential claims, reimbursement, or program participation issues
Experience maintaining ACO policies, documentation, and reporting procedures
Experience serving as the primary operational liaison with ACO partners and consultants

Responsibilities

Manage daily operations associated with ACO LEAD participation.
Monitor Medicare expenditures against established financial benchmarks.
Analyze monthly capitation payments, risk-adjusted revenue, utilization, and shared savings projections.
Identify opportunities to reduce unnecessary hospitalizations, emergency department utilization, and avoidable healthcare spending.
Develop monthly financial and operational ACO performance dashboards.
Work with leadership to forecast annual ACO profitability and financial exposure.
Coordinate with the ACO partner regarding performance reports, financial reconciliation, and contractual obligations.
Lead the organization's hierarchical condition category (HCC) risk adjustment strategy.
Monitor patient risk scores, coding completeness, and documentation accuracy.
Collaborate with providers to identify and appropriately document clinically supported chronic conditions.
Coordinate annual comprehensive assessments and documentation reviews.
Identify gaps in risk adjustment documentation and ensure timely correction.
Develop provider education initiatives to improve coding accuracy and compliance.
Track risk-score trends and the financial implications of risk adjustment.
Manage ACO patient attribution, alignment, and enrollment processes.
Identify eligible Medicare beneficiaries within Seniority's existing patient population.
Reconcile attribution rosters with internal patient records.
Monitor additions, removals, eligibility changes, and beneficiary alignment.
Collaborate with clinical and administrative teams to maximize appropriate ACO participation.
Coordinate the onboarding of newly aligned patients and ensure completion of required documentation.
Develop and maintain patient attribution tracking tools.
Analyze hospital admissions, readmissions, emergency department visits, skilled nursing utilization, and other high-cost services.
Identify patients at elevated risk for hospitalization.
Coordinate with clinical operations to deploy targeted interventions.
Collaborate with care management teams to support transitions of care.
Monitor post-acute utilization and opportunities to improve discharge planning.
Evaluate utilization patterns across senior living communities and home-based populations.
Develop actionable reports highlighting avoidable spending and opportunities for improvement.
Oversee ACO quality reporting requirements.
Monitor preventive care, chronic disease management, medication management, and other applicable quality measures.
Collaborate with providers and clinical leadership to close care gaps.
Establish quality improvement initiatives and track outcomes.
Ensure data accuracy and timely submission of required quality information.
Support provider education regarding ACO performance expectations.
Develop and maintain an ACO performance dashboard.
Integrate information from claims, EHR, billing, care management, and ACO partner data sources.
Produce weekly operational reports and monthly executive summaries.
Identify trends in patient spending, utilization, risk scores, quality metrics, and financial performance.
Translate complex data into practical recommendations for clinical and executive leadership.
Ensure data integrity across reporting platforms.
Maintain working knowledge of CMS ACO LEAD requirements and applicable Medicare regulations.
Coordinate compliance with program requirements, reporting deadlines, and beneficiary protections.
Monitor billing practices involving CCM, RPM, CoCM, and other care management services.
Collaborate with billing and compliance teams to identify potential claims, reimbursement, or program participation issues.
Maintain ACO policies, documentation, and reporting procedures.
Serve as the primary operational liaison with ACO partners and consultants.