Medicare Programs Strategy Director

Role Overview

• Lead system-wide strategy and implementation of Medicare programs, including MSSP, CMMI models (e.g., TEAM, LEAD, AHEAD), Medicare Advantage contracting (including D-SNP), and value-based care initiatives.
• Serve as internal Medicare payment and policy subject matter expert.
• Oversee regulatory analysis, rule monitoring, and dissemination of CMS updates to operational and clinical leaders.
• Serve as internal owner for Medicare contract performance.
• Coordinate cross-functional teams (finance, population health, quality, analytics, legal, compliance, IT) to ensure Medicare program requirements are met.
• Lead development of annual Medicare performance dashboards and executive reports.
• Run point on compiling and presenting quarterly performance to leadership.
• Support financial modeling of Medicare initiatives, including benchmarking, risk adjustment, and shared savings forecasts.
• Partner with compliance to ensure enterprise compliance with Medicare regulations, reporting requirements, beneficiary notifications, IT regulations (e.g. promoting interoperability) and model-specific obligations.
• Oversee submission of required CMS documentation (e.g., FALs, participation agreements, quality reporting files).
• Identify opportunities to enhance Medicare performance, reduce avoidable utilization, improve quality scores, improve acuity performance, and strengthen patient outcomes.
• Manage relationships with BMCHS government affairs, CMS, payers, external partners, and industry associations.
• Drive system readiness for new or updated CMS programs through education, communication, and operational playbooks.
• Lead the initiative to identify, evaluate, and collaborate with executive leadership to implement a new payer contract analysis tool that meets the financial analysis and reporting needs of BMCHS and the new physician group, BMCAP.
• Manage vendor relationships, contract negotiations, and oversee the deployment and integration of the selected tool.
• Use data-driven insights to provide strategic recommendations to hospital and physician group leadership.
• Collaborate with financial leadership to ensure alignment of payer contracts, reimbursement structures, and financial performance reporting.
• Build and maintain strong relationships with internal and external stakeholders, including physicians, hospital administrators, and payers.

Requirements

• Bachelor’s degree required, preference for concentration in policy, economics, finance or healthcare administration.
• Master’s degree (MBA, MPH, JD) preferred
• At least 7-10 years of experience in healthcare or related industry is required; ACO administration experience preferred
• At least 7-10 years of experience with government payment programs, policy and/or strategy, Medicare specifically required

Benefits

• medical insurance
• dental insurance
• vision insurance
• pharmacy benefits
• discretionary annual bonuses
• merit increases
• Flexible Spending Accounts
• 403(b) savings matches
• paid time off
• career advancement opportunities
• resources to support employee and family well-being