Clinical Quality & Payor Strategy Manager | FT | Weekdays

Methodist Le Bonheur Healthcare

About The Position

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One! We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South. The Manager, Clinical Quality & Payor Strategy is responsible for leading strategic initiatives and operational execution across multiple Medicare Advantage and value-based care programs. This role serves as a subject matter expert in quality metrics, electronic health record workflows, and payer partnerships, driving performance improvement and alignment with organizational goals. The manager collaborates with internal teams, external partners, and payors to optimize care delivery, enhance patient outcomes, and ensure compliance with CMS-aligned models. This includes translating payor requirements into actionable workflows, monitoring performance and visit compliance, and implementing feedback loops that support continuous improvement. Models appropriate behavior as exemplified in MLH Mission, Vision and Values. Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence. A Brief Overview The Manager, Clinical Quality & Payor Strategy is responsible for leading strategic initiatives and operational execution across multiple Medicare Advantage and value-based care programs. This role serves as a subject matter expert in quality metrics, electronic health record workflows, and payer partnerships, driving performance improvement and alignment with organizational goals. The manager collaborates with internal teams, external partners, and payors to optimize care delivery, enhance patient outcomes, and ensure compliance with CMS-aligned models. This includes translating payor requirements into actionable workflows, monitoring performance and visit compliance, and implementing feedback loops that support continuous improvement. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Requirements

Associates Degree Healthcare Administration
Associates Degree Nursing
Associates Degree Public Health
Bachelor's Degree
High School Diploma or Equivalent
5-7 years
Minimum of six (6) years of experience in Medicare and Value-Based Programs
Proven experience in people management and program management
Familiarity with Medicare Advantage payors, ACO structures, and CMS-aligned quality frameworks.
Strong understanding of Medicare Advantage, value-based care models, and payor incentive structures.
Knowledge of compliance standards for patient visits, documentation, and quality reporting.
Skilled in strategic planning, workflow development, and cross-functional coordination.
Ability to monitor performance metrics and implement feedback loops for continuous improvement.
Ability to manage multiple meetings and projects in a fast-paced environment.
Excellent communication and stakeholder engagement skills across clinical, administrative, and external teams.
Comfortable interpreting payor contracts and operationalizing requirements into scalable workflows.
Proficient in managing multi-partner projects and navigating complex healthcare environment.

Nice To Haves

Experience with Epic EHR and population health tools preferred
Substitutions allowed: In lieu of a Associate’s degree, the candidate must have a high school diploma with eight (8) years of direct clinical care coordination or social work

Responsibilities

Leads strategic planning and execution of value-based quality initiatives across multiple Medicare Advantage payors.
Serves as subject matter expert for internal quality metrics and EHR workflows, providing education, troubleshooting, and optimization support.
Develops and manages operational workflows for strategic programs including UHC Fastpass, MdRev, FindHelp, and Aledade, ensuring alignment with organizational goals.
Coordinates with external partners and internal stakeholders to expand services, improve care delivery, and support program growth.
Facilitates quality governance by organizing committee meetings, preparing agendas, and presenting updates.
Provides strategic and operational support to Population Health teams, including clinical staff and program managers.
Monitors compliance with payor-specific visit requirements and documentation standards, ensuring alignment with CMS and contract expectations.
Implements performance tracking and feedback mechanisms to support continuous improvement across clinics and teams.
Collaborates with IT and clinical teams to optimize EHR workflows that support care gap closure and quality reporting.
Represents the organization in meetings with ACOs and Medicare Advantage payors to drive performance and strategic alignment.