SummaryThis is an individual contributor role with no direct reports.
The Healthcare Performance Improvement Manager drives measurable improvements in quality, patient outcomes, and cost of care within a value-based care environment. This role supports performance across programs such as Accountable Care Organizations (ACO), Medicare Advantage, and other risk-based or population health models.
Working in close partnership with clinical, operational, and analytics teams, this role identifies performance gaps, implements data-driven interventions, and supports providers in achieving sustainable improvements across healthcare quality and utilization metrics.
Key ResponsibilitiesPerformance Improvement & Value-Based Care
- Lead initiatives to improve performance across healthcare quality measures (e.g., CMS, HEDIS) and cost/utilization metrics
- Identify care gaps and variation in performance using clinical, claims, and operational data
- Implement evidence-based strategies to improve outcomes, including care gap closure, chronic disease management, and utilization reduction
- Drive improvements in areas such as readmissions, emergency department utilization, and preventive care
Data Analysis & Reporting
- Analyze healthcare performance data, including quality metrics, utilization trends, and risk adjustment indicators (RAF/HCC), to identify opportunities
- Monitor and report on KPIs related to quality, cost, and patient outcomes
- Translate data into actionable insights for clinical and operational leaders
Provider & Stakeholder Engagement
- Partner with physicians, care teams, and operational leaders to drive performance improvement initiatives
- Support provider education on quality metrics, documentation, and value-based care expectations
- Collaborate with internal teams and external partners, including payers, as needed
Regulatory & Program Alignment
- Support initiatives aligned with CMS programs, including MSSP, Medicare Advantage, and other value-based models
- Stay current on changes in healthcare quality programs and reimbursement models
Operational Execution
- Lead cross-functional initiatives and ensure execution of performance improvement efforts
- Coordinate with care management, analytics, and operations teams
- Track progress and ensure accountability for outcomes
QualificationsRequired Experience
- Minimum 5+ years of experience in healthcare performance improvement, quality improvement, population health, or healthcare operations
- Experience working with healthcare quality metrics (e.g., CMS measures, HEDIS) and/or utilization management
- Demonstrated ability to drive improvements in patient outcomes, quality performance, or cost of care
Skills & Competencies
- Strong understanding of value-based care concepts and healthcare quality measurement
- Experience analyzing healthcare data (clinical, claims, or operational)
- Familiarity with care gap identification, population health strategies, or utilization management
- Exposure to risk adjustment (RAF/HCC) preferred
- Ability to work with and influence clinical stakeholders
- Strong communication, analytical, and problem-solving skills
Education
- Bachelor’s degree in healthcare administration, public health, nursing, or related field required
- Master’s degree preferred
Preferred (Not Required)
- Experience working in an ACO, Medicare Advantage plan, CIN, MSO, or similar environment
- Experience with CMS programs such as MSSP or Star Ratings
- Lean Six Sigma or performance improvement certification