Job Description

JOB SUMMARY:

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.

ESSENTIAL JOB FUNCTIONS:

Program Implementation & Management

• 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.

Provider Engagement & Education

• 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.

Care Coordination & Population Health

• 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.

Program Compliance & Participation Management

• 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.

Cross-Functional Collaboration

• 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.

Required Qualifications :

Education:

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

Experience:

• 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.

Skills & Competencies:

• 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.

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