Ground every answer in facts on this page and the original listing. We never invent Glassdoor-style reviews or salaries that are not in our data.
Be ready to walk through a Medicare quality or risk-adjustment initiative you led: baseline, interventions, stakeholders, and outcomes. Expect scenarios on incomplete documentation, measure underperformance, and coordinating Aspire Health–style programs inside a health system.
Strong fit if you have Medicare quality or risk-adjustment program experience and can lead without day-to-day clinical practice. Less fit if you want pure bedside nursing or software-only work with no regulatory quality context.
As Medicare Quality & Risk Adjustment Program Lead for Aspire Health at Montage Health, a typical day centers on Medicare quality metrics and risk-adjustment operations: reviewing performance data, aligning clinical and coding partners, tracking documentation gaps, and driving corrective work. Expect cross-team meetings, measure reporting, and program governance—not bedside care.
Prioritize Medicare quality programs (e.g., Stars-related measures), HCC/risk adjustment literacy, and healthcare data fluency. Useful practice includes chart-review workflows, provider education, and audit-ready documentation. No certification list or costs were provided in the source data.
No. The listing flags remote as off and places the job in the United States.
It appears as the program brand within Montage Health; the lead owns Medicare quality and risk-adjustment work under that umbrella.
None were in the supplied data—do not assume pay bands or star ratings.
Website: montagehealth.org
Public cache only — not an employee review.
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.
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