HOW YOU'LL MAKE AN IMPACTYour Role:- Attains and maintains the highest level of accreditation as Primary Care Medical Home.
- Collaborates with FMRP faculty, residents, and staff to drive continuous quality improvement and assurance.
- Provides skills, knowledge, and expertise in performance improvement tools and techniques.
- Works with Administrator to support and facilitate change that leads to improvement.
- Supports communication and reporting related to improvement through preparation and delivery of reports, presentations, and visual materials.
- Assists with teaching and inspections to ensure regulatory readiness.
Reports To:Supervises:WHAT YOU'LL NEED TO APPLYThe Manager of Quality & Value-Based Care is responsible for leading, developing, and implementing quality improvement and value-based care initiatives across a large multi-specialty medical group. This position drives performance improvement strategies that enhance clinical outcomes, patient experience, operational efficiency, and financial performance under value-based reimbursement models.
The Manager serves as a strategic partner to physicians, operational leaders, care teams, and executive leadership to ensure the organization meets quality benchmarks, regulatory requirements, population health goals, and payer performance targets. This role oversees quality programs, performance analytics, gap closure initiatives, risk adjustment activities, care coordination efforts, and value-based contracts.
Essential Duties and Responsibilities- Lead quality improvement programs and performance initiatives that support organizational goals and patient outcome improvements.
- Develop, implement, and monitor quality management strategies using evidence-based improvement methodologies.
- Analyze quality, operational, financial, and population health data to identify trends, improvement opportunities, and organizational performance gaps.
- Oversee value-based care programs, including Medicare Advantage, MSSP, ACOs, commercial value-based contracts, bundled payment arrangements, and pay-for-performance initiatives.
- Develop strategies to maximize quality incentives, shared savings opportunities, and overall contract performance.
- Partner with physicians and clinical leaders to improve quality metrics, HEDIS measures, STAR Ratings, MIPS performance, patient satisfaction, and clinical outcomes.
- Create and maintain provider performance scorecards and dashboards to support accountability and performance improvement.
- Lead population health initiatives focused on chronic disease management, preventive care, care gap closure, annual wellness visits, transitions of care, and patient engagement.
- Identify high-risk patient populations and collaborate with care teams to implement targeted intervention strategies.
- Ensure compliance with CMS, NCQA, Joint Commission, HIPAA, and other regulatory and accreditation requirements.
- Coordinate quality reporting, regulatory submissions, and documentation related to quality performance programs.
- Collaborate with coding and clinical documentation teams to improve risk adjustment accuracy, RAF scores, and documentation integrity.
- Monitor utilization, readmissions, emergency department utilization, total cost of care, and quality outcomes to support organizational goals.
- Facilitate quality committees, performance review meetings, root cause analyses, and corrective action planning.
- Support care coordination programs designed to improve patient outcomes, reduce avoidable utilization, and enhance continuity of care.
- Develop annual quality work plans, performance objectives, and strategic initiatives aligned with organizational priorities.
Required Education:- Graduate of a school of Nursing
Preferred Education:- Bachelor's Degree in Nursing (BSN)
Required Experience:- Five (5) years related experience demonstrating quality improvement/assurance skills and abilities.
Required Certification/License/Registry:- Licensed as a registered nurse (RN) in accordance with Florida Statutes (FS), Title XXXII (Regulation of Professions and Occupations), Chapter 464 (Nursing), Part I (Nurse Practice Act) [includes multistate compact licensure]
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