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BL
Blue Cross Blue Shield Association

Head of Medicare Performance Hub

Salary$198k – $278k
Location34 Locations
Work modehybrid
Typefull-time
DepartmentMedicare
Company size10,000+ people
First seen2w ago
Last seen5d ago
About the role
The Senior Director, Medicare Performance Hub (MPH) is a leadership role within the Blue Cross Blue Shield Association (BCBSA) Medicare business operations team. This individual will serve as the primary programmatic owner and operational lead for the MPH — a core enabling function designed to drive performance improvement in the areas of Star Ratings, Risk Adjustment, and Medical Cost Management.
The MPH leader will oversee the build-out, operationalization, and ongoing governance of the Hub, translating national program data and analytic insights into targeted, actionable guidance for Plans. This role sits at the intersection of analytics, clinical performance, provider performance, plan engagement, and vendor management — requiring a leader who can fluently navigate data-driven strategy while managing complex stakeholder relationships across internal BCBSA teams, Blue Health Intelligence (BHI), analytics platform partners, and the Blue System.
The Hub is designed to provide contract-level performance intelligence and member-level insights that enable Plans to execute local actions that improve Stars performance, coding accuracy, and medical cost outcomes. The MPH does not execute locally — it equips, enables, and holds Plans accountable. Plans retain responsibility for direct member and provider engagement; the MPH provides the intelligence infrastructure and consultative support that makes that engagement effective.
Responsibilities
The MPH will:
•Proactively identify benchmarks and performance targets across Stars, Risk Adjustment, and Medical Cost Management
•Monitor performance in real time where data and technology allow, and retrospectively identify gaps and remediation pathways
•Deliver actionable, member-level insights to Plans via dashboards and direct consultative engagement
•Coordinate with analytics platform partners, BHI, and BCBSA clinical and analytic staff to operationalize performance data
•Establish governance and accountability structures, including escalation pathways, corrective action plans, and Plan performance incentive frameworks
Analytics Oversight & Vendor Management
• Serve as the business owner and primary BCBSA liaison for the MPH analytics platform vendor, accountable for program and Plan level performance and deliverables against contract terms
• Partner with the analytics vendor to build management and operational dashboards providing national, regional, and Plan-specific performance views with drill-down capability to provider, geography, and member level
• Collaborate with BHI to develop benchmark and target-setting methodology for the Plan Performance Incentive Program (PIP) across Stars, Medical Cost Management, and Risk Adjustment coding accuracy
• Oversee data integration strategies across key data types — including Parts C and D claims, clinical supplemental data, encounters, and Risk Adjustment Files (RAF) — working across FEPOC, BCBSA IT, and Plan data and analytics leads
• Manage MPH data access and license strategy for Plans, in coordination with BCBSA IT and the analytics vendor
• In coordination with BHI, leverage VRDC, NDW, and other Blue-sourced data to establish program-wide benchmarks and performance targets
Program Leadership & Strategy
• Lead the design, implementation, and ongoing management of the Medicare Performance Hub
• Develop and execute the MPH operating model, including engagement processes with Plans and vendors, business review cadences, best practice sharing, and escalation/remediation protocols
• Establish and manage the MPH governance framework, engaging with Plan CEOs, leadership, BCBSA senior management, and the Board of Managers and Directors as appropriate
• Define and maintain MPH scope — distinguishing national programmatic functions from local Plan responsibilities — and ensure alignment across all stakeholders
The posting range for this position is:
$198,175.00 - $278,053.00
Qualifications:Education
•
Required BS or equivalent experience
•
Preferred MS in Health Administration, Public Health, Business Administration, or a related field preferred
Experience
•
Required 12+ Years experience in Medicare Advantage program management, health plan operations, or managed care performance improvement
Knowledge Skills and Abilities
•
Required
•
Demonstrated expertise in two or more of the following areas: CMS Star Ratings, Risk Adjustment/HCC coding accuracy, or Medical Cost Management (utilization management, care management, medical economics)
•
Proven experience managing complex, multi-stakeholder programs involving health plans, analytic vendors, and a national program office function
•
Deep understanding of Medicare Advantage data flows including Parts C and D claims, supplemental clinical data, encounter data, and CMS reporting requirements
•
Experience with managed care performance analytics and data-driven plan engagement — including the ability to translate data insights into actionable, plan-level guidance
•
Strong project management skills with the ability to manage multiple parallel workstreams across internal and external teams
•
Excellent written and verbal communication skills, with a track record of presenting complex analytic and operational information to executive audiences
•
Preferred:
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Experience working within or supporting a national Blue plan program, EGWP, or the Federal Employee Program (FEP)
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Familiarity with Medicare Advantage analytics platforms, multi-source data integration strategies, and benchmarking using CMS administrative data (e.g., VRDC, MMR, NDW)
•
Experience managing health analytics vendor relationships, including contract oversight and deliverable accountability
•
Knowledge of CMS audit, compliance, and reporting requirements applicable to Medicare Advantage plan sponsors
Extra Posting Information:
#LI-Remote
Legal
The posted salary 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 hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other 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.
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