Vice President, Medicare Stars and Risk Adjustment

Job Title: Vice President, Stars & Risk Adjustment Performance

Reports to:Senior Vice President, Government Programs

Position Overview

The Vice President of Stars & Risk Adjustment Performance is a strategic and analytical senior leader responsible for directing and monitoring all Stars and Risk Adjustment initiatives to achieve optimal outcomes. This role involves developing a unified strategy to drive efficiency and effectiveness across both programs, leveraging data and analytics to improve performance, and maximizing provider engagement to support financial goals.

The Vice President will collaborate with key stakeholders to communicate program results and advocate for Medicare business interests in cross-functional projects. This critical leadership position will influence a wide range of partners-including clinical, quality, analytics, member experience, and provider relations teams-to ensure the long-term success of the Medicare Advantage business. The ideal candidate is a natural leader with exceptional communication skills and a persuasive, thoughtful approach.

Direct Reports

This position will oversee a subject matter expert team for Stars program management and a full Risk Adjustment team, including management, data analysts, and risk coders.

Key Responsibilities

• Develop and execute a multi-year business plan for Stars and Risk Adjustment, analyzing the interrelationships of product, operations, and program performance.
• Establish, track, and drive performance targets and Key Performance Indicators (KPIs) for both Stars and Risk Adjustment programs.
• Lead provider network engagement strategies to improve performance in Stars and Risk Adjustment.
• Maintain expert knowledge of CMS regulations, industry trends, and best practices in Medicare Stars and Risk Adjustment.
• Lead regular meetings with cross-functional teams, including Pharmacy, HEDIS, CAHPS, HOS, Operations, Provider Network and Analytics, as part of the operational model that includes a hierarchy of steering meetings and domain Stars work groups and specific workgroups with synergies for both Stars and Risk Adjustment Accuracy.
• Analyze and communicate the business implications of federal legislative changes, market dynamics, and competitive threats, providing recommendations for action.

Qualifications

Required Experience & Skills:

• A minimum of 15 years of leadership experience in Medicare Advantage Stars and/or Risk Adjustment.
• Expert knowledge of Medicare Advantage Stars, Risk Adjustment, Provider Contracting, Product Development, Operations, Finance, and Analytics.
• In-depth understanding of the Medicare Part D program, including operations, practices, and industry trends.
• Demonstrated strength in analysis, problem identification, and resolution.
• Proficiency with Medicare data and system interfaces.
• Proven ability to collaborate with corporate planning leaders to execute a strategic plan.
• Strong financial and analytical skills.
• Excellent written, verbal, and interpersonal communication skills.
• Ability to lead and manage deliverables through others in a highly matrixed environment.
• Demonstrated ability to take ownership of problems and independently develop solutions.
• High degree of professionalism with the ability to interact effectively with all levels of the organization and external parties.
• Highly organized and capable of managing multiple projects simultaneously.

Education:

• Bachelor's Degree required.

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

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