Population Health Manager

The Population Health Manager will lead efforts to improve health outcomes across a diverse patient population through value-based care strategies and population health initiatives. This role oversees a team of Population Health Specialists and Outreach Coordinators and is responsible for leveraging data-driven insights to manage patient panels, reduce care gaps, and improve quality performance metrics. The manager will support value-based contracts by driving initiatives that enhance preventive care utilization, reduce avoidable utilization (e.g., ED visits, hospitalizations, and readmissions), and address health disparities. This position plays a key role in advancing the organization's mission of delivering equitable, high-quality, and cost-effective care to underserved communities. Essential job functions: Lead and mentor the Population Health team, providing guidance, support, and performance feedback. Foster a collaborative and accountable team environment to drive outreach initiatives aligned with value-based care goals and quality performance targets. Analyze population health and utilization data to identify trends, care gaps, and high-risk patient cohorts. Translate findings into actionable strategies to improve quality metrics and risk stratification. Prepare reports and present insights to executive and clinical leadership. Collaborate with clinical and administrative teams to develop, implement, and refine population health strategies that improve chronic disease management, preventive screening rates, and patient engagement, while supporting performance in value-based programs (e.g., HEDIS, Medicare Advantage, and Medi-Cal). Act as a liaison between departments, ensuring alignment of population health initiatives with clinical operations, care coordination, and quality improvement efforts. Facilitate regular meetings and discussions to support goal alignment. Track and report on key performance indicators (KPIs) related to population health, such as screening completion rates and access to preventive care. Monitor performance against benchmarks and adjust strategies to optimize results. Oversee outreach and care gap closure workflows to minimize workflow inefficiencies, ensure timely outreach, enhance patient care experience, improve patient engagement, and achieve optimal outreach outcomes. Ensure population health activities comply with FQHC guidelines and align with federal and state regulations. Promote best practices in population health management and care coordination. Performs other job duties as required by manager/supervisor. Qualifications: Bachelor’s degree in Public Health, Health Administration, Nursing, or a related field (Master’s preferred) 3-5 years of experience in population health, public health, or care coordination, preferably within an FQHC or community health setting Experience with data analysis and reporting; proficiency in population health management software and electronic health records (EHR) systems Knowledge of federal and state health care regulations, FQHC guidelines, and population health best practices is a plus Language: Must be able to fluently speak, read and write English. Bilingual in Chinese or Spanish is a plus. #J-18808-Ljbffr Fute