Care Pathway Program Manager

Nicklaus Children's Hospital•Miami, FL

About The Position

The Care Pathway Program Manager is responsible for developing, implementing, and optimizing evidence-based care pathways across NCPS to promote consistent, high-quality care delivery throughout the patient care continuum. The Program Manager role supports value-based care (VBC) initiatives and specialty programs by establishing the operational infrastructure, workflows, performance metrics, and reporting mechanisms necessary to achieve quality, utilization, and financial goals. Leverages clinical, operational, and payer data to identify care gaps, drive performance improvement efforts, and enhance patient outcomes. Oversees care pathways performance, supports HEDIS and other quality reporting initiatives, ensures accurate patient attribution and panel management, and translates contractual and regulatory requirements into actionable workflows and clinical processes. The Care Pathway Program Manager partners closely with physicians, clinical leaders, operations, quality, population health, and managed care team to drive standardized execution, measurable results, continuous improvement and scalable care models framework that supports NCPS growth in coordinated, care strategies, and value-based care objectives.

Requirements

Bachelor's Degree in Healthcare Administration, Business Management, or related field
2-4 years of experience with healthcare data analysis and interpretation
2-4 years of experience with quality reporting programs, documentation standards and audit readiness
2-4 years of experience in care coordination / case management activities
2-4 years of experience with clinical documentation and panel work
2-4 years of experience supporting pediatric quality measures

Nice To Haves

Master's degree (MHA, MPH, MSN, MBA) preferred.
Proficiency in data management and analysis tools (Excel, SQL, or data visualization/reporting software).
Knowledge of healthcare quality measures, including HEDIS.
Familiarity with Electronic Health Records (EHR) systems and practice management software.
Strong problem-solving and organizational skills, with excellent attention to detail.
Excellent communication skills, able to present data to non-technical stakeholders.
Experience with BI tools (e.g., Tableau, Power BI).
Knowledge of CPT, ICD-10 codes, and clinical coding systems.
Understanding of healthcare regulations and industry standards.
Able to work in a fast-paced environment.
Able to work collaboratively with clinical, operational, and administrative teams.
Ability to leverage and interpret data from various reporting sources, translating complex information into meaningful analyses and executive-level presentations for a broad range of stakeholders.
Strong understanding of mandatory reporting requirements, incident management processes, and escalation protocols to ensure timely resolution of patient and workplace safety concerns.
Quality improvement mindset with the ability to test, monitor, and continuously refine processes; familiarity with PDSA methodology is a plus.
Familiarity with payer portals and care management tools.
Strong clinical documentation knowledge to support measure-compliant documentation.
Strong foundation in pediatric care and common chronic conditions (e.g., asthma, ADHD, obesity, diabetes, developmental delays).

Responsibilities

Compiles and analyzes performance metrics for the physician group, creates monthly reviews, and provides insights to leadership on operational efficiency, patient flow, and resource utilization.
Prepares data for financial and operational systems and notifies managers of any outstanding items prior to meetings for accurate reporting. Tracks progress and addresses gaps in reports, working with providers to submit accurate data.
Monitors and resolves issues related to insurance panels, ensuring accurate participation data and proper documentation for timely updates.
Works closely with billing and operations teams to investigate discrepancies in panel data, credentialing, and patient eligibility.
Collaborates with registration team to optimize schedule for wellness visits (WCVs), and disease specific follow up according to diagnosis and KPIs.
Assists with data collection, analysis, and reporting to meet quality of care indicators and other set KPIs on agreed-upon timelines.
Maintains and updates databases and spreadsheets for key performance indicators, ensuring completeness for reporting and analysis.
Partners with clinical and operational teams to improve workflow efficiency and support quality improvement initiatives.
Provides regular updates on performance metrics, insurance panel status, and HEDIS progress.
Creates the infrastructure, workflows, and performance management needed to achieve quality and cost metrics while maximizing clinical and financial outcomes.
Develops processes to close care gaps based on payer-goals and best practices.
Offers support to all NCPS area to resolve discrepancies and close data gaps. Liaison to external partners, managed care team, and other key stakeholders to ensure accurate and timely data, and process.