The Manager of Ambulatory Value-Based Care (VBC) drives performance across all outpatient value-based contracts, including Medicare Advantage, ACO, and commercial arrangements. This role oversees care gap closure, quality improvement, risk adjustment, and cost-of-care initiatives across Midland Health’s employed physician practices as well as MQA who ask for VBC training. The manager collaborates with physicians, clinic directors, analytics, finance, and compliance teams to ensure strong results in quality, patient experience, and financial performance.

SHIFT AND SCHEDULE

Full Time, Monday - Friday; 8:00 AM - 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Design, implement, and oversee outpatient care models aligned with value-based care principles.
• Collaborate with Physicians, APP Providers, clinical and administrative teams to ensure seamless care coordination and transitions.
• Collaborate with VBC Plans and ACO Representatives on ongoing goals and objectives, reviewing monthly dashboard, scorecards, clinical algorithm and other initiatives.
• Supervise quality specialist, care coordinators, case managers, and other outpatient staff involved in value-based programs.
• Provide coaching, training, and performance evaluations to ensure team success across all VBC MQA providers.
• Serve as liaison between outpatient teams, payers, and leadership to align goals and communicate outcomes.
• Facilitate multidisciplinary meetings and case reviews to support high-risk patient management.
• Ensure adherence to regulatory requirements and payer contract terms.
• Prepare and present reports on program performance, utilization trends, and financial impact.

EDUCATION AND EXPERIENCE

• Bachelor’s degree in Nursing, Healthcare Administration, Public Health, or related field (Master’s preferred)
• 3+ years of experience in outpatient care management, population health, or value-based care programs
• Strong knowledge of CMS programs, ACOs, HEDIS, HCC risk adjustment, MIPS, and care coordination models
• Proven leadership and team management skills
• Excellent communication, analytical, and project management abilities

PREFERRED SKILLS

• RN, LVN or clinical license
• Experience with Athena, or other EHR platforms
• Familiarity with payer portals and analytics tools
• Certification in Case Management (CCM) or Value-Based Care

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

•  Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.