This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
You will step into a high-stakes, mission-critical role where you own the operational engine that allows Pearl Health to scale its impact on value-based care. By mastering the complexities of CMS provider submissions and ACO operations, you will directly safeguard the integrity of our networks and enable compliant operations and access to enhanced benefits for our members. This is an invitation to build operational resilience from the ground up, transitioning a vital function from a 'heroic effort' to a sustainable, best-in-class program that scales with our growth.
Job Responsibility:
Lead the end-to-end Provider Submission process, serving as the accountable leader for roster accuracy and CMS deadlines during critical windows
Manage the Roster Management System (RMS) workflow, overseeing the transition of provider data into a streamlined, automated submission process
Provide strategic oversight and execution of Beneficiary Enhancement (BE) and Beneficiary Engagement Incentive (BEI) programs, ensuring all BE/BEI filings are accurate and compliant with CMS standards
Direct the development of educational materials and training programs for internal Pearl employees to socialize complex ACO regulatory requirements
Oversee mandatory CMS operational tasks, including CEHRT compliance, MSSP applications, and the coordination of beneficiary notification letters
Responsible for CMS-related knowledge management and partnership with the Program Owner and SMEs to modernize our program operations, documenting processes to eliminate 'sausage-making' during peak cycles
Manage external resources and contractors during high-volume periods to maintain high quality-control standards under tight regulatory pressure
Requirements:
Orchestrate complex, multi-phase project lifecycles, ensuring seamless delivery within high-pressure environments and rigid deadlines
Maintain a zero-margin-for-error standard while overseeing the ingestion and processing of high-volume, mission-critical data sets
Proactively identify and resolve bottlenecks in data-intensive workflows to prevent downstream inaccuracies
Deep technical knowledge of value-based care programs (eg. ACO REACH and/or MSSP) and regulations, with the ability to translate complex CMS guidelines into actionable project plans
Accountability for regulatory deadlines, with a proven track record of meeting multi-stakeholder filing requirements without constant oversight
Nice to have:
Direct experience with CMS provider submissions, having successfully managed at least one full roster cycle for an ACO or similar value-based care entity
Experience implementing or managing a Roster Management System (RMS) or similar tool used to automate provider data flows
Background in CMS program management or policy, particularly experience with BEI programs and compliance frameworks
Prior leadership in a high-growth startup environment, where you have successfully transitioned tactical 'sprint' work into repeatable programmatic systems
What we offer:
Eligible for a discretionary performance bonus and equity options