Value-Based Care Program Manager - Healthcare

Value-Based Care Program Manager

The Value-Based Care Program Manager is a key member of the leadership team. This role leads operational and strategic initiatives across our value-based care portfolio driving performance, leading case management teams, and ensuring alignment between clinical excellence, quality outcomes, 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 to advance our value-based mission. Compensation & Benefits $85,000 $120,000 annually (DOE). Medical, dental, and vision coverage; retirement; paid vacation; CME/licensure reimbursement. Hybrid/remote flexibility with periodic in-person collaboration.

Responsibilities:

• Lead the development and execution of case management and wrap-around programs supporting ECM, transitional care, and high-risk population initiatives.
• Direct, coach, and mentor a multidisciplinary team (RN, LCSW, CHW, non-clinical navigators) to ensure accountability, engagement, and excellence in care delivery.
• Manage quality, utilization, and cost metrics across multiple payer contracts; identify performance trends and lead improvement initiatives.
• Design scalable workflows, standard operating procedures, and technology 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, shaping strategies around HEDIS, TCM, ECM, and STAR measures.
• Drive adoption of new initiatives, training, and policy updates across 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 Healthcare Administration (Master's preferred).
• 5+ years in healthcare management, including at least 3 years leading case management 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 health reporting.
• Exceptional leadership, analytical, and cross-functional communication skills.
• Demonstrated success building or scaling care management programs within Medi-Cal or Medicare settings.
• Preferred Certifications: RN, LCSW, Case Management, or CCM.