Manager, Quality & Value-Based Care
About The Position
The Manager of Quality Performance & Reporting leads Together Women’s Health’s MIPS reporting, quality improvement initiatives, and payer quality incentive programs across its practice network. The role serves as the subject matter expert for MIPS, CMS quality programs, value-based care contract quality programs, and new value-based care initiatives. The manager partners with clinical leadership, practice operations, managed care, finance, and analytics to align quality strategy with reimbursement and value-based care objectives. This is a remote position with occasional travel to payer meetings or organizational sites as needed. The role also oversees participation in value-based care initiatives and payment models, supports quality performance tracking and analytics, and works with clinical and operational teams to improve performance, documentation, and accountability.
Requirements
- Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or a related field.
- At least 5 years of healthcare quality, healthcare performance improvement, or population health experience.
- Direct experience managing MIPS reporting.
Nice To Haves
- Master’s degree (MHA, MPH, or MBA).
- Experience with commercial payer incentive programs and HEDIS.
- Experience in a multi-site physician group or health system environment.
Responsibilities
- Provide oversight and management of participation in Physician-Hospital Organization, Value Based Care Initiatives, Clinically Integrated Care models, alternative payment models, and risk-based arrangements.
- Lead the full lifecycle of MIPS, including measure selection, data validation, monitoring, and submission.
- Oversee reporting across Quality, Promoting Interoperability, Improvement Activities, and Cost categories.
- Ensure compliance with CMS requirements and maintain audit-ready documentation.
- Analyze performance trends and implement strategies to improve composite scores and payment adjustments.
- Educate providers and operational leaders about MIPS specifications and documentation requirements.
- Monitor annual CMS rule changes and implement operational updates.
- Manage performance tracking for commercial and Medicare Advantage quality programs, including HEDIS, Stars, and other pay-for-performance contracts.
- Identify care gaps and partner with practice leaders to implement corrective action plans.
- Lead workflow optimization initiatives to improve documentation integrity and operational performance.
- Collaborate with Managed Care and Finance to reconcile incentive payments and validate quality-based revenue.
- Develop annual performance targets aligned with payer metrics and quality measures for value-based care contracts.
- Support and maintain dashboards monitoring quality metrics at provider and practice levels.
- Validate EHR and claims-based data integrity.
- Conduct root cause analyses for underperforming measures.
- Provide monthly and quarterly performance reporting to executive leadership.
- Model the financial impact of quality performance relative to incentive structures.
- Work with the CMO, physicians, advanced practice providers, and practice managers to drive engagement and accountability.
- Lead interdisciplinary quality meetings focused on performance improvement.
- Support documentation and coding optimization initiatives in partnership with revenue cycle.
- Assist with regulatory surveys and internal audits as needed.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Paid time off
- 401(k) plan
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What This Job Offers
Job Type
Full-time
Career Level
Manager
