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Manager, Medicare Operations

Pearl Health

Pearl Health

New York, NY, USA · Boston, MA, USA · Remote
Posted on Friday, February 9, 2024

Who we are. . .

Pearl Health is restoring the independence and joy of practicing medicine for doctors in the United States. Our healthcare system has burdened our doctors with too much process, while removing them from what they do best: caring for those we love most. We are a team of physicians and public health experts (Stanford, Dartmouth, Harvard, Mass. General), technologists (athenahealth, Apple, Amazon, Meta, Flatiron, WalMart Health), healthcare innovators (Oscar, Aledade, VillageMD, Stellar, Arcadia) and experienced risk management professionals (CVS/Aetna, Humana, Cigna, United) who believe that primary care providers (PCPs) are the key to the United States’ future health. Pearl recently announced a strategic partnership to proliferate value-based care with Walgreens, one of the largest healthcare companies in the country. Our investors include Andreessen Horowitz, Viking Global Investors, AlleyCorp, and SV Angel.

Pearl Health helps PCPs who are overwhelmed by the demands of an aging population and the unpredictable business model inherent to Traditional Medicare. Over time, this solution will empower PCPs to provide better care to their entire patient population. We believe there is a need to bring humanism back to healthcare by giving physicians the ability to better allocate their time with patients, increasing their autonomy, creating incentives that are aligned with achieving better outcomes through clinical decision-making powered by actionable intelligence, and making risk more available and more readily optimized through an intelligent marketplace. The Center for Medicare and Medicaid (CMS) is launching a new value-based care program to disrupt Traditional Medicare, and we believe that this represents an opportunity to achieve the meaningful change we envision.

The role. . .

We are looking for a stellar Medicare Operations Manager to join our ACO Operations and Strategy team as a subject matter expert and operator of our Medicare ACO programs. This candidate will work cross-functionally with our Customer Success, Product, Performance Operations, Clinical Strategy, Data Science, and Growth teams to drive the operational excellence of our ACOs on behalf of our provider partners. This role demands a strategic thinker with the desire to implement initiatives across our growing value-based care lines of business. Strong attention to detail and the ability to work independently and collaboratively in a fast-paced environment will be crucial in this role.

  • Lead cross-functional initiatives related to the efficient and seamless operation of our Medicare ACOs, including voluntary alignment, health equity planning, quality measure management, CMS communications, and much more.
  • Support the execution of our quality measurement and reporting program on behalf of payer and provider partners.
  • Engage in the CMS submission process of information to contractual partners on behalf of our providers and ensure adherence to all ACO program-related requirements.
  • Collaborate and manage touch-points with external stakeholders, including the federal government, national advocacy organizations, and other partners.
  • Operationalize patient- and provider-facing programs to support patient engagement in their healthcare journey.

Who you are. . .

  • Bachelor’s degree or equivalent work experience.
  • 3+ years of experience in healthcare operations roles and/or excited and eager to learn more about Medicare ACO operations with a proven record of success
  • Deep understanding of the healthcare industry, with an emphasis on Medicare programs (eg. ACO REACH, MSSP, Medicare Advantage).
  • Highly analytical (strong previous utilization of spreadsheets) and passion for data-driven problem-solving with experience in interpreting clinical quality data analytics and outcomes measurements to drive change.
  • Exceptional attention to detail, with the ability to organize and operationalize projects. Ownership and accountable mentality.
  • Excellent communication and presentation skills, with the ability to clearly and effectively communicate complex ideas to diverse audiences.
  • Ability to work quickly and adjust priorities gracefully.

Our Values

We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Our definition of diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. We believe all of our colleague’s points of view are integral to our success, and that inclusion is everyone's responsibility and a cause of beautiful things.

We welcome candidates from all backgrounds and are committed to a fair hiring process free from discrimination and focused around problem solving, improvement, and mutual empowerment.

Remote Work

We are a remote-first company, with a concentration of team members at our NYC headquarters and in the Boston area.

Compensation and Benefits

The salary range Pearl Health expects to pay for this position is between $90,000-$110,000 per year. Full time employees are also eligible for annual discretionary bonus. Where a given candidate falls within that range will depend on a variety of factors, including, but not limited to, the candidate’s relevant skills, experience and location, labor market conditions and participation, if any, in other compensation arrangements. Pearl Health provides its employees a competitive benefit package - for more information please review our benefits page.

Agency Submissions

We are not currently working with contingency search firms. If a resume is submitted to any Pearl Health employee by a third party without a valid written and signed search agreement, it will become the property of Pearl Health and no fee will be paid, irrespective of whether the candidate is hired.