This 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.
Performance Improvement & Value-Based Care
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Lead initiatives to improve performance across healthcare quality measures (e.g., CMS, HEDIS) and cost/utilization metrics
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Identify care gaps and variation in performance using clinical, claims, and operational data
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Implement evidence-based strategies to improve outcomes, including care gap closure, chronic disease management, and utilization reduction
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Drive improvements in areas such as readmissions, emergency department utilization, and preventive care
Data Analysis & Reporting
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Analyze healthcare performance data, including quality metrics, utilization trends, and risk adjustment indicators (RAF/HCC), to identify opportunities
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Monitor and report on KPIs related to quality, cost, and patient outcomes
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Translate data into actionable insights for clinical and operational leaders
Provider & Stakeholder Engagement
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Partner with physicians, care teams, and operational leaders to drive performance improvement initiatives
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Support provider education on quality metrics, documentation, and value-based care expectations
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Collaborate with internal teams and external partners, including payers, as needed
Regulatory & Program Alignment
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Support initiatives aligned with CMS programs, including MSSP, Medicare Advantage, and other value-based models
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Stay current on changes in healthcare quality programs and reimbursement models
Operational Execution
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Lead cross-functional initiatives and ensure execution of performance improvement efforts
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Coordinate with care management, analytics, and operations teams
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Track progress and ensure accountability for outcomes
Required Experience
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Minimum 3+ years of experience in healthcare performance improvement, quality improvement, population health, or healthcare operations
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Experience working with healthcare quality metrics (e.g., CMS measures, HEDIS) and/or utilization management
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Demonstrated ability to drive improvements in patient outcomes, quality performance, or cost of care
Skills & Competencies
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Strong understanding of value-based care concepts and healthcare quality measurement
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Experience analyzing healthcare data (clinical, claims, or operational)
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Familiarity with care gap identification, population health strategies, or utilization management
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Exposure to risk adjustment (RAF/HCC) preferred
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Ability to work with and influence clinical stakeholders
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Strong communication, analytical, and problem-solving skills
Education
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Bachelor’s degree in healthcare administration, public health, nursing, or related field required
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Master’s degree preferred
Preferred (Not Required)
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Experience working in an ACO, Medicare Advantage plan, CIN, MSO, or similar environment
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Experience with CMS programs such as MSSP or Star Ratings
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Lean Six Sigma or performance improvement certification
