Head of Medicare Performance Hub

What you'll do

• Serve as the primary owner for the Medicare Performance Hub to drive improvements in Star Ratings, Risk Adjustment, and Medical Cost Management.
• Translate national program data into actionable, member-level insights and tailored guidance for individual Plans.
• Manage the relationship and contract deliverables with the analytics platform vendor to ensure high-quality performance reporting.
• Establish governance structures, including escalation pathways, corrective action plans, and performance incentive frameworks.
• Oversee data integration strategies across claims, clinical records, and Risk Adjustment files to inform program analytics.
• Provide consultative support to Plans to identify and close care gaps and improve coding accuracy.
• Develop and maintain the medical cost management playbook to address key drivers like readmission rates and high-cost claimants.
• Define and manage the Hub's operating model, including engagement processes, business reviews, and stakeholder communication.

What we're looking for

• Bachelor’s degree or equivalent experience required; Master’s in Health Administration, Public Health, or Business preferred.
• 12+ years of experience in Medicare Advantage program management, health plan operations, or managed care performance improvement.
• Demonstrated expertise in at least two areas: CMS Star Ratings, Risk Adjustment/HCC coding accuracy, or Medical Cost Management.
• Proven experience managing complex, multi-stakeholder programs involving health plans and analytics vendors.
• Deep understanding of Medicare Advantage data flows including Parts C and D claims, clinical data, and CMS reporting requirements.
• Experience with managed care performance analytics and translating data insights into actionable plan-level guidance.
• Strong project management skills to manage multiple parallel workstreams across internal and external teams.
• Excellent communication skills with a track record of presenting complex information to executive audiences.