Job Summary

The Care Management Program Manager is a core member of the Care Management (CM) program development and operations team and serves as a cross-functional team collaborator. This role shapes the CM program using the voice of our members, market staff and executive stakeholders to support, design, and improve our CM programs. This position plays a critical role in standardizing CM processes across all markets, promoting scalability and efficiencies to support quick company growth. 

Duties and Responsibilities

• Collaborate with technology, operations, and other program teams to influence and shape the CM program design and strategy, drive change for key issues.
• Prioritize programmatic changes based on issue volume, members impacted, utilization/revenue impact, and other relevant metrics.
• Develop dashboards and reports to monitor performance metrics, utilization, and health outcomes.
• Analyze trends in CM key performance and process measures, HEDIS, CAHPS, STAR, NCQA, and state-specific quality metrics in collaboration with our QI team.
• Identify gaps in care management and propose evidence-based interventions.
• Conduct root cause analyses and statistical evaluations of quality and performance data.
• Translate evidence-based care models and clinical guidelines into operational workflows.
• Lead implementation of pilot programs and scale-up strategies using implementation science frameworks (e.g., RE-AIM, PDSA).
• Collaborate with care teams to embed best practices across care teams.
• Support QI initiatives aligned with value-based contract requirements and CMS/state performance targets
• Act as the primary CM point of contact for various AbsoluteCare teams as the CM SME, participating in model of care design, collecting feedback from other departments, and communicating it back to the leadership team in an actionable way.
• Aggregate and analyze team and member feedback using internal tools, surveys, and available data to gather insights and propose actionable process improvements or program development.
• Work with the learning development/training team to drive creation of CM content to ensure the CM team is provided with key job training and answers to frequently asked questions.
• Draft and maintain CM policies and procedures, job aids, training content, and program descriptions.
• Drive continuous learning cycles and quality review processes in collaboration with clinical teams.
• Design and manage project timelines, milestones, and communication plans for new initiatives.
• Coordinate multi-site project teams using Agile or Lean project management methods.
• Facilitate stakeholder engagement and training during program rollouts.
• Work closely with medical economics, data scientists, business analysts and product teams.
• Partner with stakeholders on comparative best practices and population health innovations.
• Meet deadlines and manage competing priorities.

Minimum Qualifications

• Bachelor’s level required with advanced degree in clinical practice, informatics, health services or business preferred, e.g., MSN, MPH, MHA, MBA.
• Clinical licensure preferred (e.g., RN, APN, CNS, LCSW).
• 5+ years of experience in care management, population health, or quality analytics in a value-based care setting.
• Experience with complex government-sponsored populations preferred, e.g., Medicaid, Medicare beneficiaries.
• Ability to analyze data to identify and implement process improvements.
• Proven record of ability to lead through change in a dynamic environment.
• Demonstrated experience in one or more of the following: program evaluation, data analytics, implementation science, continuous quality improvement.
• Advanced Excel, and intermediate to advanced skills with SQL, Power BI, or other data visualization tools.
• Knowledge of regulatory standards, value-based purchasing, and healthcare quality frameworks (e.g., NCQA, CMS QI measures).
• Advanced computer skills with proficiency in Outlook, Word, Power Point, Excel.
• Excellent oral and written communication skills with ability to format and present to internal and external stakeholders.
• Advanced ability to influence in a matrixed environment.
• Excellent organizational and time management skills to prioritize and meet deadlines.

Working conditions

This job operates in a remote location from your home location.  This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other privacy policies.  A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.  This role requires 50% travel to market locations.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates the computer, keyboard, copy and fax machine, phone, and other general office equipment.
• Ability to meet travel requirements, e.g., air travel for multiple hours.

• Ability to occasionally move objects up to 20 lbs.

Direct reports

• None