Accountable Care Organization (ACO) Manager

No Nights! | No Weekends! | No Holidays!

Must be located in-NJ, PA, DE, or NY

Position: Accountable Care Organization (ACO) Manager
Location: Hybrid or Remote (NJ, PA, DE, NY)
Employment Type: Full-Time

Seniority Healthcare is seeking an experienced, analytical, and results-driven full-time ACO Manager to oversee the organization's participation in value-based care programs, with a primary focus on the CMS ACO LEAD Model beginning in 2027.

Seniority Healthcare provides primary care, behavioral health, chronic care management, and palliative care services to medically complex, high-risk geriatric patients in senior living communities and home-based settings.

The ACO Manager will be responsible for optimizing financial and clinical performance through risk adjustment, patient attribution, quality reporting, utilization management, and Medicare program compliance.

This individual will serve as the operational leader for ACO performance, working closely with clinical leadership, providers, care management, billing, and executive leadership to maximize shared savings opportunities while improving patient outcomes.

Key Responsibilities

1. ACO Performance & Financial Management

• Manage daily operations associated with ACO LEAD participation.
• Monitor Medicare expenditures against established financial benchmarks.
• Analyze monthly capitation payments, risk-adjusted revenue, utilization, and shared savings projections.
• Identify opportunities to reduce unnecessary hospitalizations, emergency department utilization, and avoidable healthcare spending.
• Develop monthly financial and operational ACO performance dashboards.
• Work with leadership to forecast annual ACO profitability and financial exposure.
• Coordinate with the ACO partner regarding performance reports, financial reconciliation, and contractual obligations.

2. Risk Adjustment & HCC Optimization

• Lead the organization's hierarchical condition category (HCC) risk adjustment strategy.
• Monitor patient risk scores, coding completeness, and documentation accuracy.
• Collaborate with providers to identify and appropriately document clinically supported chronic conditions.
• Coordinate annual comprehensive assessments and documentation reviews.
• Identify gaps in risk adjustment documentation and ensure timely correction.
• Develop provider education initiatives to improve coding accuracy and compliance.
• Track risk-score trends and the financial implications of risk adjustment.

Primary Objective: Ensure accurate representation of the clinical complexity of Seniority's high-risk geriatric population.

3. Patient Attribution & Enrollment

• Manage ACO patient attribution, alignment, and enrollment processes.
• Identify eligible Medicare beneficiaries within Seniority's existing patient population.
• Reconcile attribution rosters with internal patient records.
• Monitor additions, removals, eligibility changes, and beneficiary alignment.
• Collaborate with clinical and administrative teams to maximize appropriate ACO participation.
• Coordinate the onboarding of newly aligned patients and ensure completion of required documentation.
• Develop and maintain patient attribution tracking tools.

4. Utilization Management & Cost Reduction

• Analyze hospital admissions, readmissions, emergency department visits, skilled nursing utilization, and other high-cost services.
• Identify patients at elevated risk for hospitalization.
• Coordinate with clinical operations to deploy targeted interventions.
• Collaborate with care management teams to support transitions of care.
• Monitor post-acute utilization and opportunities to improve discharge planning.
• Evaluate utilization patterns across senior living communities and home-based populations.
• Develop actionable reports highlighting avoidable spending and opportunities for improvement.

5. Quality Measures & Clinical Performance

• Oversee ACO quality reporting requirements.
• Monitor preventive care, chronic disease management, medication management, and other applicable quality measures.
• Collaborate with providers and clinical leadership to close care gaps.
• Establish quality improvement initiatives and track outcomes.
• Ensure data accuracy and timely submission of required quality information.
• Support provider education regarding ACO performance expectations.

6. Data Analytics & Reporting

• Develop and maintain an ACO performance dashboard.
• Integrate information from claims, EHR, billing, care management, and ACO partner data sources.
• Produce weekly operational reports and monthly executive summaries.
• Identify trends in patient spending, utilization, risk scores, quality metrics, and financial performance.
• Translate complex data into practical recommendations for clinical and executive leadership.
• Ensure data integrity across reporting platforms.

7. Regulatory Compliance & Program Administration

• Maintain working knowledge of CMS ACO LEAD requirements and applicable Medicare regulations.
• Coordinate compliance with program requirements, reporting deadlines, and beneficiary protections.
• Monitor billing practices involving CCM, RPM, CoCM, and other care management services.
• Collaborate with billing and compliance teams to identify potential claims, reimbursement, or program participation issues.
• Maintain ACO policies, documentation, and reporting procedures.
• Serve as the primary operational liaison with ACO partners and consultants.