Value-Based Care Program Manager

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.

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  $85,000 – $120,000 annually (DOE).

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  Medical, dental, and vision coverage; retirement; paid vacation; CME/licensure reimbursement.

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  Hybrid/remote flexibility with periodic in-person collaboration.

Responsibilities

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  Lead the development and execution of case management and wrap-around programs supporting ECM, transitional care, and high-risk population initiatives.

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  Direct, coach, and mentor a multidisciplinary team (RN, LCSW, CHW, non-clinical navigators) to ensure accountability, engagement, and excellence in care delivery.

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  Manage quality, utilization, and cost metrics across multiple payer contracts; identify performance trends and lead improvement initiatives.

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  Design scalable workflows, standard operating procedures, and technology integrations that enhance care coordination and compliance.

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  Serve as the primary operational liaison to health plans — representing the company and performance-improvement discussions.

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  Partner with analytics to translate insights into action, shaping strategies around HEDIS, TCM, ECM, and STAR measures.

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  Drive adoption of new initiatives, training, and policy updates across case management and quality teams.

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  Provide executive-level reporting, dashboard interpretation, and performance summaries to support leadership decision-making.

Requirements

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  Bachelor’s degree in Nursing, Social Work, Public Health, or Healthcare Administration (Master’s preferred).

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  5+ years in healthcare management, including at least 3 years leading case management or population-health teams.
  (Managed a team of 5 or more)

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  Strong background in value-based care, risk adjustment, or health plan collaboration.

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  Expertise in quality frameworks (HEDIS, NCQA, DHCS, CMS) and population health reporting.

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  Exceptional leadership, analytical, and cross-functional communication skills.

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  Demonstrated success building or scaling care management programs within Medi-Cal or Medicare settings.

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  Preferred Certifications:
  RN, LCSW, Case Management, or CCM.