Program Manager or Sr DOE - Provider Incentives

Cambia Health-posted about 1 month ago

$100,300 - $149,500/Yr

Full-time • Mid Level

Hybrid • Portland, OR

5,001-10,000 employees

Ambulatory Health Care Services

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Every day, Cambia's dedicated team of Program Managers are living our mission to make health care easier and lives better. As a member of the Risk Adjustment and Stars team, our Program Managers partner with cross functional teams to develop, drive, and lead strategic initiatives to successfully meet Government Programs goals and objectives. Responsible for building trusting relationships between all stakeholders in provider incentive programs and Government Programs teams by understanding each team's vision, strategy and business objectives and establishing credibility as a trusted expert resource to influence positive outcomes - all in service of making our members' health journeys easier. Are you passionate about driving meaningful change in healthcare through strategic collaboration? Are you energized by the challenge of aligning multiple stakeholders toward common goals? Then this role may be the perfect fit.

Extensive experience with Medicare, Quality, Stars and Risk Adjustment activities, including the ability to educate internal teams and providers on the importance of these activities to the success of Regence and provider organizations
Strong experience in evaluating and managing multiple complex programs to ensure they achieve business objectives and deliver measurable outcomes
Advanced knowledge of health insurance industry trends, Commercial, FEP, and Medicare legislation, regulations, and exposure to integrated finance and delivery models as they relate to population health management and improving member health outcomes
Advanced communication and facilitation skills with all levels both within and outside the organization, including the ability to identify problems, develop solutions, and implement chosen courses of action to resolve complex issues and build consensus
Experience leading and motivating others by influencing and leading through ambiguity, with the ability to thrive in extremely fast-paced environments
Proven ability to coordinate initiatives and bring people together across multiple locations and functions while working effectively across highly matrixed organizations
Strong problem-solving skills with demonstrated ability to think about population health, clinical, and business problems in innovative ways and clarify key issues in complex situations
Expertise in developing and implementing strategic solutions that drive organizational success while managing competing priorities and stakeholder interests

Bachelor's degree (Master's preferred) in Nursing, Public Health, Healthcare or Business Administration or related field
Minimum 5 years relevant experience in a population health in a large healthcare delivery, health insurance or health care consulting organization with specific Medicare/Government Programs or clinical/population health experience including demonstrated experience leading a program or equivalent combination of education.
Demonstrates extensive experience with Medicare, Quality, Stars and Risk Adjustment activities, including the ability to educate internal teams and providers on the importance of these activities to the success of Regence and provider organizations
Possesses strong experience in evaluating and managing multiple complex programs to ensure they achieve business objectives, with advanced knowledge of health insurance industry trends, Commercial and Federal Employee Program (FEP) legislation, regulations and exposure to integrated finance and delivery models as they relate to population health management and improving member health outcomes
Serves as the Government Programs subject matter expert and primary point of contact for all Quality Incentive Programs (QIP) stakeholders and for providers with more complex QIP and provider incentives issues and questions
Collaborates with teams that support Network Management with Medicare-specific data and education, while maintaining responsibility for Provider Incentive Program development, related metrics, and program operations
Acts as the liaison between QIP/provider incentives and Network Management to ensure transparency, effective communication and alignment, while maintaining general knowledge of value-based arrangements, including contract terms and performance targets
Exhibits advanced communication and facilitation skills with all levels both within and outside the organization, including the ability to identify problems, develop solutions, and implement chosen courses of action to resolve complex issues and build consensus while leading and motivating others through ambiguity in fast-paced environments
Demonstrates experience coordinating initiatives and bringing people together across multiple locations and functions while working across a highly matrixed organization, with advanced problem-solving skills and the ability to think about population health, clinical and business problems in new ways
Supports internal and external partners in developing strong working relationships with strategic providers to develop and/or support incentive/performance strategies that produce improved outcomes for members and enhance the member experience while providing mutual strategic benefit for the provider and Regence

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.

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