Job description
We are currently seeking a highly motivated Lead, Value-Based Care Programs within the Quality Department. This role will report to the Medical Director, Value-Based Care Programs overseeing the accountable care organization (ACO) programs. The Lead will collaborate with cross-functional work groups to develop and implement ACO quality performance improvement workflows and a scalable data reporting program to maintain compliance with CMS quality reporting requirements. This role also utilizes advanced project management skills and builds strong organizational relationships to implement and manage initiatives. The Lead, Value-based Care Programs provides strategic guidance to ensure the successful completion of quality reporting requirements to maintain compliance with ACO regulations and addresses quality performance gaps in partnership with our provider market teams to improve physician engagement on key program outcomes.
What You'll Do
Partners with ACO and Value-Based Care Programs leadership to align program strategy with organisational goals and performance objectives
Serves as primary owner for MSSP Quality Reporting, overseeing processes, deliverables, and compliance with program requirements
Drives quarterly and annual quality reporting, ensuring accuracy, timeliness, and adherence to MSSP and other value-based care standards
Uses data analytics and reporting to increase visibility into performance, identify trends, and proactively monitor quality outcomes.
Independently investigates and resolves complex quality performance and reporting issues, identifying root causes and implementing corrective actions
Acts as escalation point for quality performance, reporting, and data-related concerns from participating physician practices and internal stakeholders
Evaluates reporting workflows and operational processes; recommends improvements to enhance efficiency, data integrity, compliance, and overall program effectiveness
Provides and coordinates training for Provider Relations and Market Managers to support providers in meeting ACO quality performance and reporting requirements
Serves as subject matter expert on MSSP quality reporting, quality measure performance, and value-based care program requirements
Engages in clinical and quality programmes to ensure regulatory changes, program developments, and reporting requirements are communicated to leadership and participating physicians
Develops and supports internal and external clinical and quality initiatives through all project phases to improve care coordination, communication, and patient outcomes
Builds and maintains effective working relationships with physician practices, healthcare partners, and cross-functional teams
Participates in and contributes to quality, clinical, and related governance committees, as needed
Escalates significant issues and risks to leadership with clear analyses and recommended solutions
Communicates complex business, operational, and technical issues, recommendations, and solutions to diverse audiences
Leads reporting-related projects, initiatives, and process improvements through expertise, influence, and cross-functional collaboration
Performs other duties as assigned
Qualifications
Education:
Bachelor’s degree in nursing, healthcare administration, business, public health or related field, or equivalent experience
Master’s degree in healthcare administration or public health preferred
Experience:
5+ years’ experience in healthcare or managed care in medical operations and/or quality improvement
License/Certifications (if applicable):
Licensed Vocational Nurse (LVN), Registered Nurse (RN), or Certified Professional Coder (CPC) preferred
Certified Professional in Healthcare Quality (CPHQ), Master of Health Administration (MHA), Master of Public Health (MPH), Project Management Program (PMP), or Lean/Six Sigma (Green or Black Belt) preferred
Knowledge, Skills, and Abilities
5+ years’ experience in program development, program management, and/or project management, preferably in healthcare
Familiarity with accountable care organization (ACO) quality reporting strongly preferred
Proficiency with commonly used electronic health record (EHR) systems strongly preferred
2+ years’ experience designing, developing, and/or implementing enterprise quality programmes across varied settings preferred
Excellent written and verbal communication skills, with the ability to tailor messaging to different audiences
Strong priority management, able to work independently and manage time and resources effectively
High proficiency in Microsoft Office (Outlook, Excel, Word, PowerPoint, SharePoint/OneDrive, Teams)
Environmental Job Requirements and Working Conditions
This position is remotely based in the U.S.
The target pay range for this role is between $85,000 - $105,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.