Program Manager - REMOTE

Job Summary

Provides program management and strategic oversight for provider engagement, quality improvement, and risk adjustment initiatives. The position is responsible for planning, coordinating, and monitoring cross‑functional programs that support regulatory compliance, quality performance, and accurate risk adjustment outcomes. Working closely with internal stakeholders and external partners, the role analyzes performance data, tracks initiatives, manages deliverables, and drives continuous improvement to support value‑based care and improved member outcomes.

• Responsible for driving provider performance and partnership across provider engagement, quality improvement, and risk adjustment initiatives.
• Ensures well‑documented policies, workflows, program controls, internal and third‑party practices, playbooks, and best practices for the respective program.
• Performs analysis of performance data and implements improvement strategies that support value‑based care, quality, risk adjustment, provider engagement, and positive member health outcomes.
• Manages program budget, as applicable, supporting project prioritization.
• Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld.
• Tracks performance metrics and ensures value realization from deployed solutions.
• Coordinates recurring meetings to support governance framework and decision‑making processes, as needed.
• At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative‑specific change and project management.
• Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices, and other collateral.
• Routinely reviews program collateral to ensure current and accurate reflection of business needs.
• Identifies opportunities/gaps and provides recommendations on program enhancements to the respective leadership team.
• Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials, and other related documentation.
• Generates and distributes standard reports on schedule.

Required Qualifications:

• At least 4 years of program and/or project management experience, or equivalent combination of relevant education and experience.
• Operational process improvement experience.
• Managed care experience, preferably in a shared service, CoE, or matrixed environment.
• Experience with Microsoft Project and Visio.
• Strong presentation and communication skills.

Preferred Experience:

• Understanding of healthcare provider engagement or payer‑provider program management.
• Experience working in managed care, health plans, or healthcare networks (Medicaid, Medicare, Marketplace).
• Knowledge of state and federal healthcare regulations, including CMS and Medicaid requirements.
• Familiarity with clinical, quality, or risk adjustment program workflows.
• Understanding of HEDIS, CAHPS, STAR Ratings, and quality benchmarking methodologies.
• Ability to interpret healthcare data and translate insights into program improvements.
• Experience tracking KPIs, closure rates, and program performance metrics.
• Detail‑oriented with strong follow‑through and accountability.