Program Manager, ACA & BHP (Hybrid)

CareFirst•Baltimore, MD

1d•Hybrid

About The Position

Drives ACA and BHP Risk Adjustment performance through performance monitoring, analytics, and strategic initiatives. Identifies trends, opportunities, and performance gaps; develops improvement strategies; and communicates results to stakeholders by translating operational performance into measurable business and financial outcomes. Collaborates across departments to improve risk adjustment revenue, forecasting accuracy, and overall program effectiveness. This role is 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 CareFirst location based on business needs and work activities/deliverables that week.

Requirements

Bachelor's Degree in Business Management or related field OR in lieu of a a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
8 years project management or program management experience.
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.
Must be eligible to work in the U.S. without Sponsorship.

Nice To Haves

Certified Project Management Professional (PMP)-PMI.
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 Commercial or ACA
5+ Provider Engagement or Provider Enablement in Commercial or ACA

Responsibilities

Analyzes aggregate ACA and BHP Risk Adjustment performance across the line of business, leveraging reporting, operational metrics, and financial results to identify trends, risks, performance gaps, and improvement opportunities.
Conducts detailed analyses of risk score performance, coding trends, transfer payment results, submission outcomes, and financial performance, translating findings into actionable recommendations that support organizational objectives.
Monitors and reports on key performance indicators, including risk score performance, coding trends, transfer payment results, submission outcomes, financial impact, and market competitiveness.
Synthesizes complex data into clear, actionable insights and communicates business implications, opportunities, and risks to leadership and P&L stakeholders.
Evaluates drivers of risk adjustment performance across ACA and BHP populations and identifies opportunities to improve risk score outcomes, transfer payment performance, and overall program effectiveness.
Reviews performance against state, regional, and national benchmarks and recommends strategies to maintain or exceed market performance.
Partners with business, clinical, operational, financial, analytics, compliance, provider, and vendor stakeholders to investigate performance drivers, validate findings, and support implementation of improvement initiatives.
Assesses the impact of regulatory and model changes on operational and financial performance and influences decision-making by connecting analytical findings to measurable business and financial outcomes.
Leads a team utilizing a matrix management system.