Program Manager of Chronic and Complex Patient Management (CCPM)

Your Role

As the Program Manager of Chronic and Complex Patient Management (CCPM) with Evergreen Nephrology, you will lead a team focused on delivering longitudinal, patient-centered care for individuals with complex and chronic conditions, including kidney disease , diabetes , heart failure , and other comorbidities. In this role, you will provide collaborative, supportive leadership and oversee the day-to-day operations of the care management team, ensuring consistent execution of proactive care strategies that improve patient outcomes. You will leverage your clinical and operational expertise to guide the management of high-risk populations, ensure adherence to established care pathways, and reduce complications, avoidable hospital admissions, and overall healthcare utilization. You will be accountable for CCPM program performance, driving results against key performance indicators (KPIs) and quality metrics. Additionally, you will support ongoing team development through coaching, training, and performance management to ensure delivery of high-quality, efficient, and patient-centered care aligned with Evergreen’s standards.

While this position is fully remote , you must be able to work 8:30am – 5pm in the Central or Eastern time zone.

Role Responsibilities

• Oversee day-to-day operations for the CCPM care management teams, ensuring efficient workflows, standardized processes, and consistent achievement of program goals.
• Ensure delivery of high-quality longitudinal chronic/complex care management, including adherence to clinical pathways, protocols, and documentation standards.
• Continuously evaluate and improve the performance of the CCPM program and team members, consistent with Evergreen’s performance management philosophy.
• Develop and implement collaborative strategies to improve program performance and patient outcomes (e.g., chronic disease control , complication prevention , and reduced readmissions ) while ensuring patient and provider partner satisfaction.
• Support newly hired CCPM team members through orientation and onboarding; provide ongoing training, coaching, and development for established team members.
• Perform regular call and documentation (chart) audits to support performance management and identify opportunities for continuous improvement.
• Prepare performance reports, dashboards (as applicable), and meeting materials for the CCPM program for internal and external audiences.
• Develop and foster relationships with key stakeholders (e.g., IDT members, market leaders, and other program leaders) to drive outcomes through collaboration and cross-program partnerships.
• Build and maintain effective communication strategies between Evergreen and market stakeholders to foster strong relationships that support improved patient outcomes, in collaboration with market leaders.
• Be a Culture Champion by cultivating a culture of high performance, transparency, trust, and collaboration.
• Other duties consistent with this role, as assigned.

Required Qualifications

• Bachelor’s degree in healthcare or nursing (BSN required)
• Active state nursing license in good standing
• 3+ years of longitudinal clinical nursing care management experience
• 2+ years of experience in a clinical nursing managerial or leadership role
• Experience in longitudinal care management
• Strong business acumen of value-based healthcare operations in disease management and population health programs
• Understanding of Business Continuity and how to build resiliency into business processes/systems
• Ability to develop talent, know when to delegate, innovate and iterate with your team, leveraging their strengths
• Exceptional relationship-building, communication, and change management skills, with the ability to influence effectively and establish trust and credibility quickly with internal and external partners
• Strong leadership presence which inspires others and instills confidence in peers, external partners, board members, and team members
• Execution-focused and hands-on, with the ability to effectively balance strategic priorities and detailed, day-to-day operational work (“in the weeds”)
• Able to motivate staff; influence people and outcomes, you promote team building
• Demonstrated ability to work effectively independently and as part of a team, in collaborative settings
• Commitment to maintaining highest level of confidentiality
• Organizational skills, operational rigor, resilience, and commitment to the business
• Intermediate skills with MS Office Suite of products including Outlook and Teams
• Able to work effectively in a remote environment:
  • Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps . Cable, Fiber, or DSL connections hardwired to the internet device are recommended
  • Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role
  • Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Master's degree in nursing or healthcare administration or related field
• Experience with quality improvement using data to track and improve program performance
• Previous experience working within a managed care environment especially with experience in administrative/management capacity
• Experience in leading the clinical function of a Value Based Care organization