Lead - Value-Based Care Programs

What You'll Do

• Partners with ACO and Value-Based Care Programs leadership to align program strategy with organisational goals and performance objectives
• Serves as primary owner for MSSP Quality Reporting, overseeing processes, deliverables, and compliance with program requirements
• Drives quarterly and annual quality reporting, ensuring accuracy, timeliness, and adherence to MSSP and other value-based care standards
• Uses data analytics and reporting to increase visibility into performance, identify trends, and proactively monitor quality outcomes.
• Independently investigates and resolves complex quality performance and reporting issues, identifying root causes and implementing corrective actions
• Acts as escalation point for quality performance, reporting, and data-related concerns from participating physician practices and internal stakeholders
• Evaluates reporting workflows and operational processes; recommends improvements to enhance efficiency, data integrity, compliance, and overall program effectiveness
• Provides and coordinates training for Provider Relations and Market Managers to support providers in meeting ACO quality performance and reporting requirements
• Serves as subject matter expert on MSSP quality reporting, quality measure performance, and value-based care program requirements
• Engages in clinical and quality programmes to ensure regulatory changes, program developments, and reporting requirements are communicated to leadership and participating physicians
• Develops and supports internal and external clinical and quality initiatives through all project phases to improve care coordination, communication, and patient outcomes
• Builds and maintains effective working relationships with physician practices, healthcare partners, and cross-functional teams
• Participates in and contributes to quality, clinical, and related governance committees, as needed
• Escalates significant issues and risks to leadership with clear analyses and recommended solutions
• Communicates complex business, operational, and technical issues, recommendations, and solutions to diverse audiences
• Leads reporting-related projects, initiatives, and process improvements through expertise, influence, and cross-functional collaboration
• Performs other duties as assigned

Qualifications

• Bachelor’s degree in nursing, healthcare administration, business, public health or related field, or equivalent experience
• Master’s degree in healthcare administration or public health preferred

• 5+ years’ experience in healthcare or managed care in medical operations and/or quality improvement

• Licensed Vocational Nurse (LVN), Registered Nurse (RN), or Certified Professional Coder (CPC) preferred
• Certified Professional in Healthcare Quality (CPHQ), Master of Health Administration (MHA), Master of Public Health (MPH), Project Management Program (PMP), or Lean/Six Sigma (Green or Black Belt) preferred

• 5+ years’ experience in program development, program management, and/or project management, preferably in healthcare
• Familiarity with accountable care organization (ACO) quality reporting strongly preferred
• Proficiency with commonly used electronic health record (EHR) systems strongly preferred
• 2+ years’ experience designing, developing, and/or implementing enterprise quality programmes across varied settings preferred
• Excellent written and verbal communication skills, with the ability to tailor messaging to different audiences
• Strong priority management, able to work independently and manage time and resources effectively
• High proficiency in Microsoft Office (Outlook, Excel, Word, PowerPoint, SharePoint/OneDrive, Teams)

Environmental Job Requirements and Working Conditions

• This position is remotely based in the U.S.
• The target pay range for this role is between $85,000 - $105,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.