Manager of Value- Programs

The Manager of Value-Based Programs is responsible for supporting the design, implementation, and daily management of value-based care initiatives aimed at improving quality, lowering costs, and enhancing patient outcomes. This role collaborates closely with clinical, operational, and administrative teams to drive performance under value-based contracts with payers. The VBD Manager ensures that organizational strategies align with payer requirements and quality metrics, and helps coordinate care management, risk adjustment, and population health activities.

• Support the execution of VB initiatives, including pay-for-performance, shared savings, and risk-based arrangements (e.g., MSSP, Medicare Advantage, Commercial ACOs).
• Monitor and track performance against contractual benchmarks for quality, utilization, and financial outcomes.
• Partner with data and analytics teams to deliver timely reports and dashboards to leadership and providers.

• Collaborate with providers and practice staff to improve performance on quality measures (e.g., HEDIS, STAR Ratings, CAHPS).
• Provide training and guidance on documentation improvement, risk adjustment, and care gap closure.
• Support implementation of provider incentive models and assist with incentive distribution analysis.

• Work with care coordination and eCW teams to implement population health strategies focused on chronic disease management, preventive care, and care transitions through eCW Pop Health Module
• Identify high-risk or high-cost patients and support care plans that improve outcomes and reduce unnecessary utilization.
• Coordinate activities that support social determinants of health (SDOH) and health equity objectives.

• Ensure compliance with payer requirements, including data submission, coding accuracy (HCC), and audit preparedness.
• Assist in reviewing and interpreting value-based contract terms and contribute to performance improvement planning.
• Help manage utilization and value-based tools such as VIM and ACO’s management platform, Identify.

• Partner with quality improvement, EHR, compliance, and revenue cycle teams to align initiatives.
• Participate in meetings with payers, provider groups, and internal leadership to review performance and identify opportunities.

• Bachelor’s degree in Nursing, Public Health, Health Administration, or a related field required.
• Coding Certifications such as CPC, CRC, CPMA, etc. are preferred

• Minimum 3–5 years of experience in value-based care, population health, managed care, or healthcare quality improvement.
• Experience working with risk-based contracts, CMS quality programs, or ACO operations preferred.
• Working knowledge of value-based payment models, HEDIS, HCC coding, and population health tools.
• Strong analytical and problem-solving skills; proficiency in Excel, Power BI, or similar tools.
• Excellent communication and interpersonal skills; ability to engage providers and clinical teams.
• Self-starter with strong organizational and project management abilities.