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Why This Role is Important to Us:

The Program Manager, in collaboration with the VP of Population Health and Network Quality Strategy, is responsible for managing and implementing key population health and network quality initiatives to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid-Medicare Plan withhold measures, quality performance metrics incorporated into other CCA contracts, health equity, and social determinants of health (SDOH) measures. The Program Manager will work collaboratively with our provider network to identify quality metrics that align contracting efforts for efficiency and effectives with alternative payment models. The Program Manager will work closely with market engagement teams, network contracting, quality analytics, and clinical teams to support implementation of alternative payment contracts and bring timely reports and actionable insights to providers for improvement.

Supervision Exercised:

No direct reports currently; however, one to three program consultants with future expansion.

What You'll Be Doing:

• Establish and maintain collaborative relationships with MA/RI provider network practices to promote engagement with CCA and optimize performance and member outcomes.

• Coordinate MA/RI market efforts on value-based care clinical/quality contract measures with primary care practices and other network providers to focus improvement on quality performance metrics (including but not limited to HEDIS, CAHPS, and HOS).

• Initiate and implement interventions to advance clinical quality and efficiency initiatives and provide consultative support to provider entities; manage Provider Advisory Council meetings.

• Manage operations of the Performance Incentive Program. Work with network contracting and the finance department to develop, track contract deliverables and execute quality payments for the value-based care contract programs.

• Review and analyze data to assess network utilization and quality performance to identify opportunities for improvement. Collaborate with business stakeholders from population health, network strategy, quality analytics, clinical informatics, clinical, pharmacy, member experience, and behavioral health teams to improve network performance and quality of care provided to members.

• Provide program management support on various improvement efforts focused on population health and quality improvement on population health, health equity, and social determinants of health.

• Act as a subject matter expert Alternative Payment Models and Quality Performance Improvement Incentives.

• Collaborate and Coordinate a wide variety of cross-functional efforts required to carry out essential duties and responsibilities involving all levels of CCA staff and management across many departments.

• Synthesize data findings into performance reports, including tracking and monitoring for trends, to be shared with external providers and during clinical quality and population health committee meetings. Identify key findings and translate findings into business implications and areas of opportunity.

Working Conditions:

Standard office conditions. In office or hybrid working conditions. Position requires occasional travel in Massachusetts and the surrounding area.

What We're Looking For:

Education Required:

• Bachelor's degree in business or health care related field

Education Desired:

• Master's degree

Experience Required:

• Minimum 5-7 years of experience in healthcare, network performance and contracting, population health, quality improvement or related area

• Experience in health care data analytics and improving publicly reported clinical quality measures required

• Experience with Medicare Advantage, Medicaid; and dually eligible populations required

Experience Desired:

• CPHQ

Knowledge, Skills & Abilities Required:

• Understanding of health care contracting and alternative payment models

• Experience in interpreting data and formulating recommendations/action plans to support network population health, quality, health equity, and social determinants of health improvement

• Intermediate to advanced computer skills necessary (Word, Excel, and PowerPoint) preferred.

• Ability to communicate quality improvement concepts and tasks to cross functional teams and with external stakeholders, including network providers

• Excellent ability to cultivate and maintain interpersonal and professional relationships across various teams and external provider partners

• Self-directed and able to plan, organize, and execute work with minimal supervision

• Ability to communicate business and technical information to people of various backgrounds

• Strong project management skills

• Experience leading and managing cross-functional projects and project teams

Language(s) Required:

• English

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.