Job Description

ABOUT US

A Specialty Path to Good Health

Upperline Health is the nation’s largest provider group dedicated to lower extremity, wound and vascular care. Founded in 2017 with the ambitious goal of transforming specialty care, Upperline Health is a pioneer in bringing value-based care models into specialty care. Upperline delivers a more efficient path for patients to receive consistent and effective treatment for chronic illnesses.

Triage is temporary.

Treatment is transformative.

Upperline Health providers coordinate patients’ care among a team of specialists – physicians, advanced practice providers, care navigators, pharmacists, dieticians, and social workers for integrated treatment that addresses patients’ immediate and long-term health needs.

We put patients at the center of value-based care.

About the Quality Program Manager
Upperline Health is seeking a Quality Program Manager responsible for overseeing, implementing, and optimizing quality performance initiatives for Upperline Health’s various value-based care contracts , with a primary focus on Medicare quality programs including CMS Star Ratings, HEDIS, and other Medicare-related quality measures. This role leads cross-functional quality improvement efforts, ensures regulatory compliance, and drives performance improvement across clinical, operational, and data teams to achieve quality, financial, and population health goals.

What You’ll Do

• Lead the planning, execution, and evaluation of Medicare quality programs, including CMS Star Ratings, HEDIS, CAHPS, and ACO quality measures
• Serve as the subject matter expert on Medicare quality measurement methodologies, specifications, and annual changes
• Translate CMS and NCQA requirements into actionable strategies for providers, care teams, and operational partners
• Monitor quality performance against benchmarks, targets, and contractual requirements
• Partner with analytics teams to develop and maintain dashboards, scorecards, and performance reports
• Identify performance gaps and trends and recommend data-driven improvement strategies
• Design and lead quality improvement projects to improve clinical outcomes, patient experience, and preventive care compliance
• Support chart review, medical record retrieval, and supplemental data submission processes
• Educate providers and staff on quality measures, documentation requirements, and performance improvement strategies
• Facilitate quality committees, workgroups, and provider meetings
• Support audits, validations, and data submissions related to Medicare quality programs
• Stay current on changes to Medicare quality programs, industry trends, and best practices in value-based care

Qualifications of the Quality Program Manager

• Bachelor’s degree in healthcare administration, public health, nursing, or a related field (Master’s degree preferred)
• 5+ years of experience in healthcare quality, population health, or value-based care
• Demonstrated experience with CMS Star Ratings, HEDIS, and Medicare quality programs
• Strong understanding of ACOs, Medicare Advantage, and value-based reimbursement models
• Proven project management and cross-functional leadership skills
• Experience working within an ACO, Medicare Advantage plan, or provider-sponsored health plan
• Familiarity with quality analytics tools, EHR systems, and claims data
• Certification in healthcare quality or project management (e.g., CPHQ, PMP) a plus

Benefits
Comprehensive benefit options include medical, dental and vision, 401K and PTO.

Compensation

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience

Job Type: Full-time