Medicare Quality & Risk Adjustment Program Lead – Aspire Health

Join Montage Health as a Medicare Quality & Risk Adjustment Program Lead, a full-time healthcare leadership position based in the United States. This role combines clinical expertise with program management, overseeing Medicare Advantage quality initiatives, regulatory compliance, and data integrity to drive organizational performance.

About the Role

As the Medicare Quality & Risk Adjustment Program Lead at Montage Health, you'll direct critical healthcare quality programs that impact organizational outcomes and patient care. Working within our quality and compliance framework, you'll champion HEDIS measurement, Stars performance initiatives, risk adjustment accuracy, and audit readiness—ensuring Montage Health meets or exceeds Medicare Advantage program standards.

What You'll Do

• Lead Medicare Advantage quality program operations, serving as the primary clinical and technical expert for HEDIS reporting, data validation, and supplemental submission strategies
• Manage risk adjustment program activities, ensuring accurate member coding, diagnosis documentation, and regulatory alignment
• Oversee Stars rating performance initiatives and develop action plans to improve quality metrics across the organization
• Coordinate internal audit readiness processes, resolve compliance gaps, and prepare for external Medicare reviews
• Collaborate cross-functionally with clinical, coding, and operations teams to embed quality standards into daily workflows
• Monitor industry updates and regulatory guidance affecting Medicare Advantage programs and inform organizational strategy

What We're Looking For

• Registered Nurse (RN) with clinical background and demonstrated expertise in Medicare Advantage programs
• Strong knowledge of HEDIS measures, quality reporting, or risk adjustment operations
• Proven program management and cross-functional leadership experience
• Detail-oriented approach with excellent analytical and organizational skills
• Ability to communicate complex healthcare and regulatory concepts to diverse teams
• Working knowledge of healthcare compliance, audit processes, and CMS requirements

About Montage Health

Montage Health is dedicated to advancing quality care and clinical excellence for the communities we serve across the United States.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.