Healthcare Performance Improvement Specialist

Job Description

Job Description

Summary

This is an individual contributor role with no direct reports.

The Healthcare Performance Improvement Manager drives measurable improvements in quality, patient outcomes, and cost of care within a value-based care environment. This role supports performance across programs such as Accountable Care Organizations (ACO), Medicare Advantage, and other risk-based or population health models.

Working in close partnership with clinical, operational, and analytics teams, this role identifies performance gaps, implements data-driven interventions, and supports providers in achieving sustainable improvements across healthcare quality and utilization metrics.

Key Responsibilities

Performance Improvement & Value-Based Care

• Lead initiatives to improve performance across healthcare quality measures (e.g., CMS, HEDIS) and cost/utilization metrics
• Identify care gaps and variation in performance using clinical, claims, and operational data
• Implement evidence-based strategies to improve outcomes, including care gap closure, chronic disease management, and utilization reduction
• Drive improvements in areas such as readmissions, emergency department utilization, and preventive care

Data Analysis & Reporting

• Analyze healthcare performance data, including quality metrics, utilization trends, and risk adjustment indicators (RAF/HCC), to identify opportunities
• Monitor and report on KPIs related to quality, cost, and patient outcomes
• Translate data into actionable insights for clinical and operational leaders

Provider & Stakeholder Engagement

• Partner with physicians, care teams, and operational leaders to drive performance improvement initiatives
• Support provider education on quality metrics, documentation, and value-based care expectations
• Collaborate with internal teams and external partners, including payers, as needed

Regulatory & Program Alignment

• Support initiatives aligned with CMS programs, including MSSP, Medicare Advantage, and other value-based models
• Stay current on changes in healthcare quality programs and reimbursement models

Operational Execution

• Lead cross-functional initiatives and ensure execution of performance improvement efforts
• Coordinate with care management, analytics, and operations teams
• Track progress and ensure accountability for outcomes

Required Experience

• Minimum 3+ years of experience in healthcare performance improvement, quality improvement, population health, or healthcare operations
• Experience working with healthcare quality metrics (e.g., CMS measures, HEDIS) and/or utilization management
• Demonstrated ability to drive improvements in patient outcomes, quality performance, or cost of care

Skills & Competencies

• Strong understanding of value-based care concepts and healthcare quality measurement
• Experience analyzing healthcare data (clinical, claims, or operational)
• Familiarity with care gap identification, population health strategies, or utilization management
• Exposure to risk adjustment (RAF/HCC) preferred
• Ability to work with and influence clinical stakeholders
• Strong communication, analytical, and problem-solving skills

Education

• Bachelor’s degree in healthcare administration, public health, nursing, or related field required
• Master’s degree preferred

Preferred (Not Required)

• Experience working in an ACO, Medicare Advantage plan, CIN, MSO, or similar environment
• Experience with CMS programs such as MSSP or Star Ratings
• Lean Six Sigma or performance improvement certification