Lead - Value- Care Programs

Department: Quality

Employment Type: Full Time

Location: Remote

Reporting To: Kevin Chang

Compensation: $85,000 - $105,000 / year

We are currently seeking a highly motivated Lead, Value-Based Care Programs within the Quality Department. This role will report to the Medical Director, Value-Based Care Programs overseeing the accountable care organization (ACO) programs. The Lead will collaborate with cross-functional work groups to develop and implement ACO quality performance improvement workflows and a scalable data reporting program to maintain compliance with CMS quality reporting requirements.

This role also utilizes advanced project management skills and builds strong organizational relationships to implement and manage initiatives. The Lead, Value-based Care Programs provides strategic guidance to ensure the successful completion of quality reporting requirements to maintain compliance with ACO regulations and addresses quality performance gaps in partnership with our provider market teams to improve physician engagement on key program outcomes.

• 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

Education:

• 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

Experience:

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

License/Certifications (if applicable):

• Licensed Vocational…