Value-Based Care Program Manager - Healthcare

Job Description
Value-Based Care Program Manager

San Diego (Hybrid)

The Value-Based Care Program Manager is a key member of the leadership team. This role leadsoperational and strategic initiatives across our value-based care portfolio - driving performance,leading case management teams, and ensuring alignment between clinical excellence, qualityoutcomes, and payer expectations.


This position requires a balance of visionary leadership and tactical execution: you'll build,refine, and scale case management-centric programs that deliver measurable results - while mentoring teams and collaborating with health plans, data teams, and executive leadership toadvance our value-based mission.


Compensation & Benefits

• $85,000 - $120,000 annually (DOE).
• Medical, dental, and vision coverage; retirement; paid vacation; CME/licensurereimbursement.
• Hybrid/remote flexibility with periodic in-person collaboration.

Responsibilities

• Lead the development and execution of case management andwrap-around programs supporting ECM, transitional care, and high-risk populationinitiatives.
• Direct, coach, and mentor a multidisciplinary team (RN, LCSW,CHW, non-clinical navigators) to ensure accountability, engagement, and excellence incare delivery.
• Manage quality, utilization, and cost metrics across multiplepayer contracts; identify performance trends and lead improvement initiatives.
• Design scalable workflows, standard operating procedures, andtechnology integrations that enhance care coordination and compliance.
• Serve as the primary operational liaison to health plans - representing the company and performance-improvement discussions.
• Partner with analytics to translate insights into action, shapingstrategies around HEDIS, TCM, ECM, and STAR measures.
• Drive adoption of new initiatives, training, and policy updatesacross case management and quality teams.
• Provide executive-level reporting, dashboard interpretation,and performance summaries to support leadership decision-making.

Requirements

• Bachelor's degree in Nursing, Social Work, Public Health, or HealthcareAdministration (Master's preferred).
• 5+ years in healthcare management, including at least 3 years leading casemanagement or population-health teams. (Managed a team of 5 or more)
• Strong background in value-based care, risk adjustment, or health plan collaboration.
• •Expertise in quality frameworks (HEDIS, NCQA, DHCS, CMS) and population healthreporting.
• Exceptional leadership, analytical, and cross-functional communication skills.
• Demonstrated success building or scaling care management programs within Medi-Cal orMedicare settings.
• Preferred Certifications: RN, LCSW, Case Management, or CCM.

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