Population Health and VBC Program Manager

ADELANTE HEALTHCARE INC•Phoenix, AZ

11d•Onsite

About The Position

The Population Health and Value-Based Care Manager develops and implements strategies to optimize health outcomes for diverse populations served by Adelante Healthcare. The role oversees population health initiatives and value-based care (VBC) programs, ensures compliance with applicable healthcare regulations, coordinates with patient care teams and operational management, and monitors program financial performance. The manager balances financial considerations with patient care priorities and cultivates partnerships with health plans to support VBC models. Adelante Healthcare leaders are expected to set clear performance expectations and measurable goals, provide ongoing feedback and coaching, and support team performance and accountability. Leaders are also expected to demonstrate commitment to the organization’s mission, vision, core values, quality, patient safety, employee engagement, and innovation, while modeling integrity, professionalism, and competence. The position manages population health and VBC program strategy, financial tracking and analysis, ACO operations tracking, and the Health Plans Audit Program. It works with clinical, operational, analytics, IT, nursing, quality improvement, and provider network teams, as well as health plans and community partners. The position may travel to health centers as required. The work may involve prolonged sitting as well as standing, walking, handling objects or controls, reaching, climbing stairs, balancing, stooping, kneeling, crouching, crawling, talking, hearing, smelling, and managing stress. Frequent lifting or moving of up to 25 pounds without assistance and occasional lifting or moving of up to 50 pounds with assistance may be required. Travel to clinic sites may expose the employee to prevailing weather conditions; clinic work may involve health hazards such as contagious diseases and blood-borne pathogens. The work environment is usually moderately noisy.

Requirements

Associate’s degree in applied sciences or equivalent.
At least 3 years of experience in population health management, value-based care, or healthcare administration; experience in an FQHC or similar setting is ideal.
High level of experience with HEDIS, UDS, AZARA, network portals, care-gap closure, data analysis, attestation forms, and performance improvement.
In-depth understanding of population health principles, VBC models, and quality improvement processes.
Strong analytical skills and experience with data analysis and healthcare data management systems.
Demonstrated ability to build partnerships with health plans and understand VBC agreements.
Strong leadership, communication, and interpersonal skills, including the ability to collaborate with diverse teams.
Proficiency in healthcare quality improvement methodologies and community health assessment frameworks.
Working knowledge of Microsoft Office applications, including Outlook, Word, and Excel.
Excellent verbal and written communication skills and the ability to communicate effectively with internal and external customers.
Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety.
CPR and AED certification for the Health Care Professional through courses following American Heart Association and Red Cross guidelines, including cognitive and skills evaluations.
Valid Arizona Driver’s License.
Ability to travel to all health centers if required.
Ability to meet the described physical demands, including frequent lifting or moving of up to 25 pounds without assistance and occasional lifting or moving of up to 50 pounds with assistance.

Nice To Haves

Bachelor’s degree preferred.
Experience in population health management, value-based care, or healthcare administration within an FQHC or similar setting.

Responsibilities

Collaborate with the Provider Network Manager to ensure adherence to contracted networks and applicable NCQA, HRSA, Arizona Department of Health, and Joint Commission standards.
Oversee regular evaluations and audits of population health and VBC work at health centers, documenting compliance, progress, and opportunities for improvement.
Schedule and provide staff training on coding, care-gap closure, population health practices, VBC principles, and data analysis tools; facilitate workshops and learning sessions.
Build relationships with providers, community organizations, health plans, and other stakeholders to support integrated healthcare solutions.
Participate in community health initiatives that improve access to care, address social determinants of health, and enhance community well-being.
Develop, implement, and monitor population health strategies for community needs, particularly those of high-risk and underserved populations.
Analyze data to identify health disparities and target interventions that improve outcomes and access to care.
Design and implement preventive care, chronic disease management, and early intervention programs.
Coordinate resources and services with providers and community organizations to support population health initiatives.
Track metrics and benchmarks, evaluate program effectiveness, adjust strategies based on performance data, and report outcomes and insights to stakeholders.
Work with nursing and medical or operations leadership to develop financial models and track the financial performance and viability of VBC initiatives and plans.
Partner with operational VBC teammates to improve care-gap closure for Medicaid, Medicare, and commercial populations, in that priority order.
Partner with Data Analytics, IT, clinical, and operational leadership to maintain accurate patient rosters for VBC programs.
Communicate VBC quality results and strategies to nursing and quality improvement leadership as needed.
Prepare and manage VBC program budgets, monitor financial targets, and develop KPIs to measure financial performance and support achievement of results.
Identify financial risks associated with VBC contracts and develop mitigation strategies with the Provider Network Manager.
Support revenue through care coordination, patient engagement, and quality improvement in partnership with operational and clinical management.
Use data analytics to assess VBC financial performance and identify areas for improvement; educate staff and providers about VBC finances and how their actions affect outcomes.
Prepare reports and presentations for internal and external stakeholders, and stay current on VBC and healthcare finance trends and practices.
Establish, with the Provider Network Manager, systems to segregate VBC payments from regular FQHC PPS prospective payments, including separate accounts or financial codes as appropriate.
Stay current with federal and state FQHC funding and reporting regulations, and ensure VBC payments remain separate from PPS and do not compromise compliance.
Prepare transparent financial reports distinguishing VBC payments from prospective payments.
Review VBC contracts with the Provider Network Manager and CSML to understand terms, conditions, and performance measures, and ensure incentives align with the FQHC’s mission and goals.
Collaborate with the Provider Network Manager to establish documented systems for standard ACO operations, including CMS reporting, patient and provider communications, claims payments, and compliance.
Work with nursing and operations teams to collect and align ACO KPI data, analyze indicators, and identify performance-improvement actions.
Use data and analytics to inform strategic decisions about ACO operations.
Oversee Adelante Healthcare’s Health Plans Audit Program and develop a documented system for timely responses to health plan audit requests.
Develop improvement plans based on internal tracers, trends, and identified problem areas when needed.
Complete other projects and duties as requested or assigned.
Promote and participate in interdisciplinary communication and collaboration through the Patient Centered Medical Home and Integrated Care Team model.
Comply with Adelante Healthcare standards, policies, procedures, Compliance Program, and Code of Conduct, and report conduct that may violate legal or compliance requirements.