Medicare Programs Strategy Director

BMC Software • Boston, MA

7d

About The Position

POSITION SUMMARY: Boston Medical Center Health System (BMC Health System) is an integrated health system comprised of the largest safety net hospital in New England and a health plan that cares for over 400,000 members across Massachusetts and New Hampshire. Our roots as a provider system date back more than 150 years to our establishment as the City of Boston’s public hospital—it is a foundation we have built upon as the provider of care to the most vulnerable individuals in the region. BMCHS plays a leading role as a safety-net system through our efforts to advance health equity , invest in new models for addressing social determinants of health, providing behavioral health treatment (e.g., our primary-care-based model for opioid addiction treatment), and more. As part of our integrated health system BMCHS operates eight Medicaid Accountable Care Organizations (ACOs) in Massachusetts; we share risk and take responsibility for quality of care for our ACO members under the program. Boston Accountable Care Organization, Inc. (BACO), is one of those ACOs - its participants consist of Boston Medical Center Hospital, about 3,000 on-campus providers, and 15 community health center partners. BMCHS has recently acquired two medical centers: St. Elizabeth's Medical Center and Good Samaritan Medical Center. With this exciting new growth, we are looking for a Medicare Programs Strategy Director to lead the strategic, operational, and regulatory oversight of all Medicare-related initiatives across BMCHS. This role leads enterprise-wide Medicare strategy, including CMMI models, Medicare Advantage, MSSP, regulatory readiness, compliance, performance improvement, and financial optimization. Position: Medicare Programs Strategy Director Department: Network Strategy Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: BMCHS Medicare Policy and Strategy Lead system-wide strategy and implementation of Medicare programs, including MSSP, CMMI models (e.g., TEAM, LEAD, AHEAD), Medicare Advantage contracting (including D-SNP), and value-based care initiatives. Serve as internal Medicare payment and policy subject matter expert. Oversee regulatory analysis, rule monitoring, and dissemination of CMS updates to operational and clinical leaders. BMCHS Medicare Contract Implementation Serve as internal owner for Medicare contract performance. Coordinate cross-functional teams (finance, population health, quality, analytics, legal, compliance, IT) to ensure Medicare program requirements are met. Lead development of annual Medicare performance dashboards and executive reports. Run point on compiling and presenting quarterly performance to leadership. Support financial modeling of Medicare initiatives, including benchmarking, risk adjustment, and shared savings forecasts. Partner with compliance to ensure enterprise compliance with Medicare regulations, reporting requirements, beneficiary notifications, IT regulations (e.g. promoting interoperability) and model-specific obligations. Oversee submission of required CMS documentation (e.g., FALs, participation agreements, quality reporting files). Identify opportunities to enhance Medicare performance, reduce avoidable utilization, improve quality scores, improve acuity performance, and strengthen patient outcomes. Manage relationships with BMCHS government affairs, CMS, payers, external partners, and industry associations. Drive system readiness for new or updated CMS programs through education, communication, and operational playbooks. Payer Contract Analysis Lead the initiative to identify, evaluate, and collaborate with executive leadership to implement a new payer contract analysis tool that meets the financial analysis and reporting needs of BMCHS and the new physician group, BMCAP. Manage vendor relationships, contract negotiations, and oversee the deployment and integration of the selected tool. Use data-driven insights to provide strategic recommendations to hospital and physician group leadership. Collaborate with financial leadership to ensure alignment of payer contracts, reimbursement structures, and financial performance reporting. Stakeholder Management Build and maintain strong relationships with internal and external stakeholders, including physicians, hospital administrators, and payers. (The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). JOB REQUIREMENTS

Requirements

• Bachelor’s degree required, preference for concentration in policy, economics, finance or healthcare administration.
• At least 7-10 years of experience in healthcare or related industry is required
• At least 7-10 years of experience with government payment programs, policy and/or strategy, Medicare specifically
• Confidence and adaptability to tackle complex and unstructured problems
• Positive attitude and willingness to own all aspects of a project
• Superb communication skills to distill complicated issues into clear recommendations
• Advanced quantitative and critical reasoning skills to structure and carry out analyses
• Strong interpersonal skills to navigate competing stakeholder interests
• Ability to work independently and with matrixed teams
• Ability to manage and prioritize across multiple projects to meet deadlines
• Strong analytic thinking
• Highest level of integrity and respect for colleagues and for our mission to provide Exceptional Care Without Exception to our patients and members

Nice To Haves

• Master’s degree (MBA, MPH, JD) preferred
• ACO administration experience preferred

Responsibilities

• BMCHS Medicare Policy and Strategy Lead system-wide strategy and implementation of Medicare programs, including MSSP, CMMI models (e.g., TEAM, LEAD, AHEAD), Medicare Advantage contracting (including D-SNP), and value-based care initiatives.
• Serve as internal Medicare payment and policy subject matter expert.
• Oversee regulatory analysis, rule monitoring, and dissemination of CMS updates to operational and clinical leaders.
• Serve as internal owner for Medicare contract performance.
• Coordinate cross-functional teams (finance, population health, quality, analytics, legal, compliance, IT) to ensure Medicare program requirements are met.
• Lead development of annual Medicare performance dashboards and executive reports.
• Run point on compiling and presenting quarterly performance to leadership.
• Support financial modeling of Medicare initiatives, including benchmarking, risk adjustment, and shared savings forecasts.
• Partner with compliance to ensure enterprise compliance with Medicare regulations, reporting requirements, beneficiary notifications, IT regulations (e.g. promoting interoperability) and model-specific obligations.
• Oversee submission of required CMS documentation (e.g., FALs, participation agreements, quality reporting files).
• Identify opportunities to enhance Medicare performance, reduce avoidable utilization, improve quality scores, improve acuity performance, and strengthen patient outcomes.
• Manage relationships with BMCHS government affairs, CMS, payers, external partners, and industry associations.
• Drive system readiness for new or updated CMS programs through education, communication, and operational playbooks.
• Lead the initiative to identify, evaluate, and collaborate with executive leadership to implement a new payer contract analysis tool that meets the financial analysis and reporting needs of BMCHS and the new physician group, BMCAP.
• Manage vendor relationships, contract negotiations, and oversee the deployment and integration of the selected tool.
• Use data-driven insights to provide strategic recommendations to hospital and physician group leadership.
• Collaborate with financial leadership to ensure alignment of payer contracts, reimbursement structures, and financial performance reporting.
• Build and maintain strong relationships with internal and external stakeholders, including physicians, hospital administrators, and payers.

Benefits

• BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 501-1,000 employees