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Purpose of Job The Manager Value-Based Programs is responsible for leading the strategic and operational execution of value-based care initiatives across the organization. This role focuses on optimizing performance under alternative payment models (APMs). including Accountable Care Organizations (ACOs), bundled payments, and risk-based contracts, while supporting cross-functional collaboration to improve quality outcomes and financial sustainability. Job Functions
- Lead the implementation and management of value-based programs such as payer incentive models, quality reporting initiatives, and alternative payment arrangements.
- Liaise with payer partners to understand contract requirements, performance expectations, and shared data insights.
- Translate payer-shared data into actionable information to inform organizational strategy, operational improvements, and clinical engagement.
- Monitor performance metrics and financial outcomes for value-based contracts; identify opportunities for improvement and lead corrective action plans.
- Collaborate with clinical, operational, and IT teams to ensure workflows, documentation, and billing practices align with program requirements.
- Serve as a subject matter expert on CMS regulations, payer requirements, and industry trends related to value-based care.
- Develop and maintain dashboards, reports, and presentations for internal stakeholders and external partners.
- Support provider engagement and education to drive adoption of value-based practices.
- Lead cross-functional projects that advance population health strategies and value-based care goals.
- Performs other duties as assigned.
Minimum Education/Work Experience
- Bachelor's degree in Nursing, Healthcare Administration, Public Health, or related field required
- Minimum of 5 years of experience in healthcare, with at least 2 years in value-based care, population health, or healthcare quality
Preferred License/Certification
- RN or other clinical licensure
- Certified Professional in Healthcare Quality (CPHQ)
- Project Management Professional (PMP) or similar credential
Preferred Qualifications
- Master's Degree in Healthcare Administration, Public Health, or related field
- Experience with payer contracting and performance-based incentive models
- Familiarity with federal and state value-based care initiatives
Knowledge/Skills/Abilities
- Strong understanding of CMS programs, risk adjustment, and alternative payment models
- Proven ability to lead cross-functional teams and manage complex projects, including quality performance
- Excellent communication, analytical, and organizational skills
- Ability to interpret and apply payer shared data to drive performance improvement
- Experience with Epic systems, data analytics tools, and payer portals preferred
Link to Physical Demands
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Ridgeview Medical Center
Oct 13, 2025