Care Pathway Program Lead - Pediatric Value-Based Care

Nicklaushealth; Miami, Northern (FL, KY); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Nicklaushealth in Florida seeks a Care Pathway Program Manager to develop, implement, and optimize evidence‑based care pathways across NCPS, supporting value-based care initiatives and quality reporting. You will work with physicians, leaders, and payers to build workflows, capture KPIs, and improve patient outcomes.

You will drive standardized execution, monitor panel data, and ensure accurate reporting for HEDIS and other measures while developing scalable care models aligned with payer goals.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Management, or related field
• 2-4 years of experience with healthcare data analysis and interpretation
• 2-4 years of experience with quality reporting programs, documentation standards and audit readiness
• 2-4 years of experience in care coordination / case management activities
• 2-4 years of experience with clinical documentation and panel work
• 2-4 years of experience supporting pediatric quality measures

Responsibilities

• Compiles and analyzes performance metrics for the physician group, creates monthly reviews, and provides insights on operational efficiency
• Prepares data for financial and operational systems and notifies managers for accurate reporting
• Monitors and resolves issues related to insurance panels and documentation
• Works with billing and operations to investigate discrepancies in panel data
• Collaborates with registration to optimize schedules for wellness visits and follow up
• Assists with data collection, analysis, and reporting to meet KPIs and timelines
• Maintains and updates databases for KPIs and reporting
• Partners with clinical and operational teams to improve workflow efficiency
• Provides regular updates on performance metrics and HEDIS progress
• Creates infrastructure and workflows to achieve quality and cost metrics
• Develops processes to close care gaps based on payer-goals
• Offers support to NCPS area to resolve discrepancies and data gaps

Skills

Data analysis

Quality reporting

Care coordination

Communication

BI tools

Tableau

Power BI

SQL

Excel

PDSA

Education

Bachelor's degree in Healthcare Administration / related field

Master's degree in Healthcare Administration / MPH / MSN / MBA

Tools

Excel

SQL

Tableau

Power BI

EHR systems

Job description

Nicklaushealth in Florida seeks a Care Pathway Program Manager to develop, implement, and optimize evidence‑based care pathways across NCPS, supporting value-based care initiatives and quality reporting. You will work with physicians, leaders, and payers to build workflows, capture KPIs, and improve patient outcomes.

You will drive standardized execution, monitor panel data, and ensure accurate reporting for HEDIS and other measures while developing scalable care models aligned with payer goals.