Program Manager, Risk Adjustment & Stars

About the role

The Program Manager, Risk Adjustment & Stars connects Alpine's technical teams (coding, data, analytics, IT) with operational and business stakeholders (leadership, quality, health plan operations) on risk adjustment and Star Ratings performance. The role turns technical details such as data pipelines, coding logic and CMS methodology into operational plans and priorities, and ensures operational requirements feed back into technical work. It does not require direct provider-facing engagement.

Key responsibilities

• Own the annual risk adjustment and Stars improvement program cycle, building timelines and reporting progress to leadership and health plan partners
• Lead cross-functional workgroups spanning coding/HCC teams, clinical quality, IT and analytics
• Liaise on HCC capture workflows, chart review pipelines, vendor coordination and RAF score trends
• Track HCC model version transitions (e.g. CMS-HCC V24/V28) and their operational and financial impact
• Coordinate Star Ratings strategy across HEDIS, CAHPS, HOS and medication adherence measures, and act as the single point of contact with health plan quality teams
• Define KPIs and dashboards, present performance results and recommendations to executive leadership and payer partners
• Ensure compliance with CMS regulations and ICD-10-CM coding guidelines, support RADV audit readiness and data validation requests

Required profile

• Bachelor's degree in health informatics, data analytics, healthcare administration, business or a related field (Master's preferred)
• 5 to 7 years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement, ideally in a value-based care setting
• Preferred: CRC credential, experience with value-based care, ACOs or delegated risk arrangements, familiarity with health plan Stars programs, PMP or similar certification
• Able to travel to meetings and work in a home office that is HIPAA compliant

Required skills

• Working knowledge of CMS HCC risk adjustment models, RAF score methodology, EDS submission and Star Ratings measure specifications
• Strong written and verbal communication, able to translate technical detail for operational and executive audiences
• Program/project management experience with cross-functional initiatives
• Proficiency in Excel; SQL, Tableau or Power BI a plus

What we offer

• Salary range of $83,990.40 to $119,974.40
• Annual bonus eligibility based on individual and/or company performance
• Medical, dental and vision insurance, 401(k), paid time off and an Employee Assistance Program