Medicare Programs Strategy Director
Boston Medical Center (BMC)
full-time
Posted on:
Location Type: Hybrid
Location: Boston • Massachusetts • United States
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Job Level
About the role
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medicare programsMSSPCMMI modelsMedicare Advantage contractingfinancial modelingbenchmarkingrisk adjustmentshared savings forecastsdata-driven insightspayer contract analysis
Soft Skills
leadershipcommunicationcollaborationrelationship managementstrategic recommendationscross-functional coordinationregulatory analysispresentation skillsproblem-solvingstakeholder engagement
Certifications
Bachelor’s degreeMaster’s degree (MBA, MPH, JD)