Care Pathway Optimization Lead

Nicklaus Children's Hospital; Miami (FL); On-site; USD 110,000 - 140,000; Full time

Job summary

Nicklaus Children's Hospital is seeking a Care Pathway Program Manager to develop and optimize evidence-based care pathways across NCPS, driving value-based care initiatives and standardized workflows.

The role requires collaboration with physicians, clinical leaders, operations, and payer teams to ensure quality metrics, panel management, and regulatory alignment. Strong data skills and pediatric care experience are preferred.

Qualifications

• Bachelor's degree in healthcare admin, business, or related field.
• 2–4 years of healthcare data analysis and interpretation.
• 2–4 years of experience with quality reporting programs and audit readiness.
• 2–4 years in care coordination / case management activities.
• 2–4 years of experience with clinical documentation and panel work.

Responsibilities

• Compiles and analyzes performance metrics for the physician group and provides insights to leadership.
• Prepares data for financial and operational systems and notifies managers of items before meetings.
• Monitors and resolves issues related to insurance panels and documentation for timely updates.
• Investigates discrepancies in panel data, credentialing, and patient eligibility with billing/ops teams.
• Collaborates to optimize wellness visit scheduling and disease-specific follow-up KPI attainment.
• Assists with data collection, analysis, and reporting for quality indicators and KPIs.
• Maintains databases/spreadsheets for KPIs and reporting completeness.
• Partners with clinical/operational teams to improve workflow and quality initiatives.
• Provides updates on performance metrics, panel status, and HEDIS progress.
• Creates workflows to achieve quality and cost metrics with strong clinical outcomes.

Skills

Data analysis

Healthcare data management

Excel

SQL

Tableau

Power BI

HEDIS

EHR systems

Quality reporting

Pediatrics

Clinical documentation

Education

Bachelor's Degree in Healthcare Administration, Business Management, or related field

Master's degree in Healthcare (MHA/MPH/MSN/MBA) preferred

Tools

Excel

SQL

Tableau

Power BI

EHR systems

Practice management software

Job description

Nicklaus Children's Hospital is seeking a Care Pathway Program Manager to develop and optimize evidence-based care pathways across NCPS, driving value-based care initiatives and standardized workflows.

The role requires collaboration with physicians, clinical leaders, operations, and payer teams to ensure quality metrics, panel management, and regulatory alignment. Strong data skills and pediatric care experience are preferred.