The Program Manager owns annual Medicare Advantage risk adjustment and Star Ratings programs, coordinating coding, clinical quality, IT, analytics, vendors, and health plan stakeholders. Responsibilities include managing timelines, HCC and chart review workflows, RAF and Stars performance, EDS reconciliation, CMS methodology changes, dashboards, data integrity, compliance, RADV audit readiness, and executive reporting. The role translates technical and regulatory information into operational plans and business decisions.
Are you looking to work for a company that has been recognized for over a decade as a Top Place to Work? Apply today to become a part of a company that continues to commit to putting our employees first.
Job Description:
OVERVIEW OF POSITION:The Program Manager, Risk Adjustment & Stars, serves as the connective link between Alpine's technical teams (coding, data, analytics, IT) and its operational and business stakeholders (leadership, quality, health plan operations) for risk adjustment and Star Ratings performance. This role translates technical details, such as data pipelines, coding logic, and CMS methodology, into operational plans, priorities, and decisions, while ensuring operational requirements and business goals are reflected back into the technical work. The role does not require direct provider-facing engagement.
ESSENTIAL DUTIES:
Program Management- Owns the annual risk adjustment and Stars improvement program cycle, coordinating between technical teams and operational/business stakeholders across prospective and retrospective programs, visit-based campaigns, and gap closure workflows.
- Builds and manages program timelines and throughput; reports progress to Alpine leadership and health plan partners in clear, business-friendly terms.
- Leads cross-functional workgroups spanning coding/HCC teams, clinical quality, IT, and analytics, ensuring technical work stays aligned to operational priorities.
- Manages program-level documentation and requirements, translating between technical specifications and operational plans.
- Acts as the liaison between coding/data teams and operational stakeholders on HCC capture workflows, chart review pipelines, and gap identification, ensuring both sides understand priorities and constraints.
- Manages relationships with vendors, coordinating technical file exchange and integration needs with operational timelines and expectations.
- Monitors RAF score trends and performance results, working with analytics teams to interpret findings and translates them into operational action plans.
- Coordinates risk adjustment data submission accuracy and reconciliation (EDS), connecting technical issue resolution with business and health plan deadlines.
- Tracks HCC model version transitions (e.g., CMS-HCC V24/V28) and communicates their operational and financial impact to leadership and business teams.
- Coordinates Alpine's Star Ratings strategy across HEDIS, CAHPS, HOS, and medication adherence measures, connecting technical measure logic with operational execution.
- Partners with analytics teams to maintain measure-level performance tracking and cut-point modeling, translating results into operational priorities and gap closure plans.
- Serves as one point of contact for Alpine with health plan Stars/quality teams, bridging technical data exchange requirements with operational and contractual needs.
- Partners with analytics and data teams to define KPIs and dashboards for RAF accuracy, coding gap closure rates, and Star measure performance, ensuring outputs are operationally useful.
- Translates CMS methodology updates (HCC model version changes, Star Ratings technical notes, measure weighting changes) for both technical teams (as specifications) and operational teams (as business impact).
- Helps identify and escalate data integrity issues across source systems (claims, EHR, supplemental data feeds), coordinating resolution between technical and operational owners.
- Presents performance results and program recommendations to Alpine executive leadership and payer partners.
- Ensures all program activities comply with CMS regulations, ICD-10-CM coding guidelines, and Alpine's compliance policies.
- Supports RADV audit readiness and health plan data validation requests, coordinating between technical teams pulling data and operational/compliance teams managing the response.
EDUCATION:
Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field (Master's preferred).
EXPERIENCE:
Five (5) to seven (7) years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement, ideally within a value-based care (VBC) setting.
Preferred Qualifications
• Certified Risk Adjustment Coder (CRC) credential.
• Experience with value-based care, ACOs, or delegated risk arrangements.
• Familiarity with multiple health plan Stars/quality programs and data exchange requirements.
• PMP or similar certification.
KNOWLEDGE, SKILLS, ABILITIES:
- Working knowledge of CMS HCC risk adjustment models, RAF score methodology, EDS submission processes, and Star Ratings measure specifications.
- Demonstrated ability to work effectively with both technical teams (data, analytics, IT) and operational/business stakeholders, translating between the two.
- Proven program/project management experience managing cross-functional initiatives involving both technical and operational workstreams.
- Working proficiency in Excel required; familiarity with SQL, Tableau, Power BI, or similar tools a plus.
- Strong written and verbal communication skills, with the ability to translate technical and regulatory detail for operational and executive audiences.
- Skilled at translating between technical and operational audiences, comfortable in both worlds without needing to be a deep technical expert.
- Strong relationship management and cross-functional collaboration skills.
- Analytical and detail-oriented, able to interpret data and technical findings and turn them into operational plans.
- Adaptable to evolving CMS methodology and health plan requirements.
- Able to travel to meetings
- Ability to handle multiple demands concurrently in a high stress environment; organize, coordinate, set priorities and meet deadlines
- Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures
Salary Range:
Salary Range: $83,990.40-$119,974.40
Additional Compensation: Eligible for annual bonus based on individual and/or company performance.
Benefits: Includes medical, dental, and vision insurance; 401(k); paid time off (PTO); and Employee Assistance Program (EAP)
Application Deadline: Open until filled. Applications will be reviewed on a rolling basis.
How to Apply: Apply via careers page at https://alpinephysicians.wd1.myworkdayjobs.com/external
Alpine Physician Partners Los Angeles, California, USA Office
Los Angeles, California, United States
Similar Jobs
Artificial Intelligence • Fintech • Insurance • Marketing Tech • Software • Analytics
Leads a team of underwriters managing complex casualty risks in the sharing economy and new mobility sectors. Oversees risk selection, portfolio profitability, pricing, coverage analysis, broker relationships, quality audits, and regulatory documentation. Coaches and develops underwriting talent, guides decisions on high-impact accounts, drives innovation, and establishes strategies for profitable portfolio growth.
Artificial Intelligence • Fintech • Software • Travel
Own full-cycle recruiting for Product Delivery roles, including Product Management, Product Design, Growth, and leadership hiring. Build sourcing strategies, market maps, interview processes, portfolio evaluation standards, rubrics, and scorecards from the ground up. Partner with senior Product, Marketing, Growth, and executive stakeholders, use recruiting data to guide decisions, represent Engine to candidates, and support GTM hiring as priorities change.
Artificial Intelligence • Fintech • Software • Travel
Own and execute the application security program, including SIEM management, threat detection, architecture and code reviews, vulnerability management, security testing, incident response, forensic investigations, and security tooling. Partner with engineering and infrastructure teams to remediate vulnerabilities, promote secure coding, develop training, and improve enterprise security through cloud, container, compliance, and monitoring practices.
Top Skills:
C#Ci/CdDastDockerIastJavaKubernetesMitre Top 25Node.jsOwasp Top 10PciPythonRubySastSIEMSoc 2
What you need to know about the Los Angeles Tech Scene
Los Angeles is a global leader in entertainment, so it’s no surprise that many of the biggest players in streaming, digital media and game development call the city home. But the city boasts plenty of non-entertainment innovation as well, with tech companies spanning verticals like AI, fintech, e-commerce and biotech. With major universities like Caltech, UCLA, USC and the nearby UC Irvine, the city has a steady supply of top-flight tech and engineering talent — not counting the graduates flocking to Los Angeles from across the world to enjoy its beaches, culture and year-round temperate climate.
Key Facts About Los Angeles Tech
- Number of Tech Workers: 375,800; 5.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Snap, Netflix, SpaceX, Disney, Google
- Key Industries: Artificial intelligence, adtech, media, software, game development
- Funding Landscape: $11.6 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Strong Ventures, Fifth Wall, Upfront Ventures, Mucker Capital, Kittyhawk Ventures
- Research Centers and Universities: California Institute of Technology, UCLA, University of Southern California, UC Irvine, Pepperdine, California Institute for Immunology and Immunotherapy, Center for Quantum Science and Engineering
