VBC Program Manager

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Report directly to the Director of VBC Operations while leading the VBC Operations Coordinators and a Patient Engagement Representative.

• Conduct weekly team huddles and monthly performance evaluations focusing on beneficiary alignment, utilization, quality, and reported expenditures.

• Monitor LEAD quality measures and Prevention and Quality Plan milestones, reporting any discrepancies to leadership.

• Track admissions, readmissions, emergency department visits, and post-acute stays; ensure that high-risk patients have designated owners and documented actions.

• Analyze CMS reports and data feeds, identify variances, and escalate risks along with suggested solutions.

• Maintain a master calendar detailing CMS deadlines and deliverables, assigning owners and follow-up actions.

• Supervise voluntary alignment in accordance with leadership targets and timelines, including pre-submission reviews.

• Reconcile CMS alignment lists with census and EHR data, leading root-cause analyses on avoidable attrition.

• Align Participant and Preferred Provider lists with HR and credentialing records at the TIN/NPI level.

• Ensure beneficiary notifications and outreach are executed and documented in compliance with CMS requirements.

• Coordinate VBC initiatives with operations managers at both facility and NP levels.

• Collaborate with VBC clinical leadership to develop workflows, checklists, and handoffs.

• Provide support for provider-facing scorecards, tip sheets, and training sessions.

• Submit and prioritize data requests, evaluate data for accuracy, and pinpoint automation prospects.

• Prepare performance summaries for senior leadership and ACO governance.

• Lead root-cause investigations and monitor action plans until completion.

• Facilitate quarterly PDSA improvement cycles that involve Finance, clinical, and data partners.

• Develop and maintain a VBC operational playbook.

• Mentor the VBC operations team, establish priorities and escalation thresholds, create SOPs, and address operational challenges.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, public health, business, nursing, or a related discipline.

• Over 4 years of experience in value-based care, ACO operations, or population health, with a preference for provider-side experience.

• Direct experience working within a CMS ACO model (such as ACO REACH, particularly in High Needs, MSSP, or LEAD).

• Background in post-acute, skilled nursing facilities (SNF), or long-term care settings.

• At least 2 years of experience in staff management.

• Proven ability to conduct recurring operational cycles and meet deadlines.

• Experience in executing structured improvement cycles (e.g., PDSA, Lean) and developing playbooks.

• Familiarity with CMS alignment (both claims-based and voluntary), ACO quality metrics, beneficiary protections, marketing requirements, and fundamentals of benchmark and settlement.

• Capability to drive follow-through among clinical, operational, and data teams without direct authority.

• Strong communication skills to articulate data insights to clinicians and leadership, and comfort with financial and utilization reports, Excel, BI dashboards, and EHR data.

• Knowledge of NP-led care teams is preferred.

• A clinical background (e.g., RN) is preferred.

• A Master's degree is preferred.

🏝️ Benefits

• Health Care Plan (Medical, Dental & Vision)

• Retirement Plan (401k, IRA)

• Life Insurance (Basic, Voluntary & AD&D)

• Paid Time Off (Vacation, Sick & Public Holidays)

• Family Leave (Maternity, Paternity)

• Short Term & Long Term Disability

• Training & Development

• Work From Home

• Free Food & Snacks

• Wellness Resources

• Limited travel to facility partners and team meetings