Value-Based Care Program Manager
About The Position
The Value-Based Care Program Manager is a key member of the leadership team. This role leads operational and strategic initiatives across our value-based care portfolio — driving performance, leading case management teams, and ensuring alignment between clinical excellence, quality outcomes, and payer expectations. This position requires a balance of visionary leadership and tactical execution: you’ll build, refine, and scale case management-centric programs that deliver measurable results — while mentoring teams and collaborating with health plans, data teams, and executive leadership to advance our value-based mission.
Requirements
- Bachelor’s degree in Nursing, Social Work, Public Health, or Healthcare Administration (Master’s preferred).
- 5+ years in healthcare management, including at least 3 years leading case management or population-health teams. (Managed a team of 5 or more)
- Strong background in value-based care, risk adjustment, or health plan collaboration.
- Expertise in quality frameworks (HEDIS, NCQA, DHCS, CMS) and population health reporting.
- Exceptional leadership, analytical, and cross-functional communication skills.
- Demonstrated success building or scaling care management programs within Medi-Cal or Medicare settings.
Nice To Haves
- Preferred Certifications: RN, LCSW, Case Management, or CCM.
Responsibilities
- Lead the development and execution of case management and wrap-around programs supporting ECM, transitional care, and high-risk population initiatives.
- Direct, coach, and mentor a multidisciplinary team (RN, LCSW, CHW, non-clinical navigators) to ensure accountability, engagement, and excellence in care delivery.
- Manage quality, utilization, and cost metrics across multiple payer contracts; identify performance trends and lead improvement initiatives.
- Design scalable workflows, standard operating procedures, and technology integrations that enhance care coordination and compliance.
- Serve as the primary operational liaison to health plans — representing the company and performance-improvement discussions.
- Partner with analytics to translate insights into action, shaping strategies around HEDIS, TCM, ECM, and STAR measures.
- Drive adoption of new initiatives, training, and policy updates across case management and quality teams.
- Provide executive-level reporting, dashboard interpretation, and performance summaries to support leadership decision-making.
Benefits
- Medical, dental, and vision coverage; retirement; paid vacation; CME/licensure reimbursement.
- Hybrid/remote flexibility with periodic in-person collaboration.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
1-10 employees
