Value-Based Managed Care Leader

Paycom; United States; On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health insurance

Job summary

Paycom seeks a Managed Care Manager to lead operational performance of the organization’s managed care and value-based contracts. You will coordinate with providers, clinic leadership, payers, and executives to translate payer requirements into actionable strategies that maximize outcomes and efficiency.

The role covers HCC/RAF capture, quality measures, utilization and care management, and performance under CMS-driven contracts. Strong collaboration and data-analytic skills are required.

Qualifications

• Bachelor's degree in Healthcare Administration or related field preferred.
• 3–5 years in healthcare operations, managed care, or value-based care.
• Experience with Medicare Advantage and/or Medicaid preferred.
• RN or LVN licensure preferred but not required where appropriate.
• Certifications in healthcare quality, managed care, coding, or population health are a plus.
• Experience with physicians and advanced practice providers is preferred.

Responsibilities

• Oversee day-to-day performance of managed care contracts, including value-based programs.
• Monitor PMPM revenue, quality incentives, and risk-adjustment revenue.
• Coordinate implementation of payer programs and performance initiatives.
• Develop provider education on documentation, RAF, and risk-adjustment requirements.
• Create provider scorecards and quality dashboards for performance review.
• Lead population health and care management initiatives with clinical teams.
• Ensure CMS and payer requirements are met in all activities.

Skills

Analytical skills

Data interpretation

Excel skills

Dashboard reporting

Communication

Project management

Education

Bachelor's degree in Healthcare Administration

Bachelor's degree in related field

Tools

Excel

Job description

Paycom seeks a Managed Care Manager to lead operational performance of the organization’s managed care and value-based contracts. You will coordinate with providers, clinic leadership, payers, and executives to translate payer requirements into actionable strategies that maximize outcomes and efficiency.

The role covers HCC/RAF capture, quality measures, utilization and care management, and performance under CMS-driven contracts. Strong collaboration and data-analytic skills are required.