Job Description
Value-Based Care Program Manager
San Diego (Hybrid)
The Value-Based Care Program Manager is a key member of the leadership team. This role leads operational and strategic initiatives across our value-based care portfolio — driving performance, leading case management teams, and ensuring alignment between clinical excellence, quality outcomes, and payer expectations.
This position requires a balance of visionary leadership and tactical execution: you’ll build, refine, and scale case management-centric programs that deliver measurable results — while mentoring teams and collaborating with health plans, data teams, and executive leadership to advance our value-based mission.
Compensation & Benefits
$85,000 – $120,000 annually (DOE).
Medical, dental, and vision coverage; retirement; paid vacation; CME/licensure reimbursement.
Hybrid/remote flexibility with periodic in-person collaboration.
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.
(Managed a team of 5 or more)
Strong background in value-based care, risk adjustment, or health plan collaboration.
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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.
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