Value-Based Care Program Manager

Jobtailor; San Diego (CA); On-site; USD 150,000 - 190,000; Full time

Job summary

Jobtailor in San Diego, CA seeks a senior leader to drive case management and wrap-around programs for ECM, transitional care, and high-risk populations. You will oversee a multidisciplinary team and ensure accountability, engagement, and excellence in care delivery.

You will partner with health plans, shape HEDIS and STAR initiatives, design scalable workflows, and provide executive reporting to inform leadership decisions.

Qualifications

• Bachelor’s degree in Nursing, Social Work, Public Health, or Healthcare Administration is required.
• 5+ years in healthcare management with 3+ years leading case management or population-health teams.
• Strong background in value-based care and health plan collaboration.
• Experience with HEDIS, NCQA, CMS/QI reporting.
• Leadership and cross-functional communication skills.
• Certifications preferred: RN, LCSW, CCM or Case Management.

Responsibilities

• Lead the development and execution of case management and wrap-around programs for ECM, transitional care, and high-risk populations.
• Direct, coach, and mentor a multidisciplinary team (RN, LCSW, CHW, navigators) for accountability and excellent care delivery.
• Manage quality, utilization, and cost metrics across payer contracts; identify trends and drive improvements.
• Design scalable workflows, SOPs, and tech integrations to enhance care coordination and compliance.
• Serve as primary operational liaison to health plans for performance-improvement discussions.
• Partner with analytics to translate insights into action on HEDIS, TCM, ECM, and STAR measures.
• Drive adoption of new initiatives, training, and policy updates across case management and quality teams.
• Provide executive reporting, dashboards, and performance summaries to support leadership decisions.

Skills

Healthcare management

Population health

Cross-functional communication

Analytics

Leadership

Education

Bachelor's degree in Nursing, Social Work, Public Health, or Healthcare Administration

Job description

Responsibilities

• Lead the development and execution of case management and wrap‑around programs supporting ECM, transitional care, and high‑risk population initiatives
• Direct, coach, and mentor a multidisciplinary team (RN, LCSW, CHW, non‑clinical navigators) to ensure accountability, engagement, and excellence in care delivery
• Manage quality, utilization, and cost metrics across multiple payer contracts; identify performance trends and lead improvement initiatives
• Design scalable workflows, standard operating procedures, and technology integrations that enhance care coordination and compliance
• Serve as the primary operational liaison to health plans — representing the company and performance‑improvement discussions
• Partner with analytics to translate insights into action, shaping strategies around HEDIS, TCM, ECM, and STAR measures
• Drive adoption of new initiatives, training, and policy updates across case management and quality teams
• Provide executive‑level reporting, dashboard interpretation, and performance summaries to support leadership decision‑making

Requirements

• Bachelor's degree in Nursing, Social Work, Public Health, or Healthcare Administration (Master’s preferred)
• 5+ years in healthcare management, including at least 3 years leading case management or population‑health teams
• Strong background in value‑based care, risk adjustment, or health plan collaboration
• Expertise in quality frameworks (HEDIS, NCQA, DHCS, CMS) and population health reporting
• Exceptional leadership, analytical, and cross‑functional communication skills
• Demonstrated success building or scaling care management programs within Medi‑Cal or Medicare settings
• Preferred Certifications: RN, LCSW, Case Management, or CCM