Provider Network Quality Strategy Program Manager

Position Summary

The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider quality performance across CCA's contracted network, with a focus on value-based arrangements and network-wide engagement strategies.

The program manager is responsible for managing and implementing key population health and network quality initiatives to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid-Medicare Plan withhold measures, quality performance metrics incorporated into other CCA contracts, health equity, Culturally and Linguistically Appropriate Services, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and social determinants of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams to identify quality metrics that align contracting efforts for efficiency and effectives with alternative payment models. The Program

This role serves as a critical bridge between Provider Engagement, Network Performance, Analytics, Clinical and Quality Teams to drive improvement in clinical outcomes, health equity, and member and provider experience.

Supervision Exercised

• No direct reports currently; however, one to three program consultants with future expansion.

Essential Duties & Responsibilities:

Provider Quality Performance and Value-Based Care

• Lead implementation and monitoring of quality initiatives tied to value-based payment programs and contractual performance metrics.
• Partner with Provider Engagement, Network, Clinical and Quality teams to evaluate provider performance, identify opportunities for improvement, and facilitate data-driven action plans.
• Collaborate with Contracting, Quality Analytics, and Population Health to align provider quality measures with value-based contracts and incentive programs.
• Translate quality performance data into actionable insights and communicate findings to provider partners to drive improvement.
• Support the development and oversight of provider pay-for-performance programs, including metric tracking, financial reconciliation, and performance reporting.

Health Equity and CLAS Integration

• Partner with the Health Equity team to incorporate CLAS (Culturally and Linguistically Appropriate Services) standards into provider education and engagement activities.
• Lead or support the development and dissemination of provider-facing resources that advance equitable care delivery.
• Coordinate provider training and communication initiatives focused on social drivers of health, cultural competence, and equity-focused performance improvement.

CAHPS Strategy and Performance

• Oversee implementation of provider-focused initiatives that support CAHPS performance improvement.
• Analyze CAHPS results to identify trends and collaborate with Provider Network, Clinical and Quality teams to address performance gaps.
• Develop and disseminate provider education and best practices to improve member satisfaction with access, communication, and care coordination.
• Track and report provider performance metrics related to CAHPS domains such as Getting Needed Care, Getting Care Quickly, Rating of Health Care, and Customer Service.
• Collaborates with Communications to design provider materials and newsletters reinforcing CAHPS-related expectations and improvement goals.
• Partners with network leadership to recognize high-performing providers and share improvement strategies.

Provider Education and Engagement

• Manage the design, scheduling, and delivery of provider quality education, including webinars, learning sessions, and quality performance updates in collaboration with Quality team.
• Develop materials and presentations that clearly communicate quality goals, contractual expectations, and best practices to the provider network.
• Serve as a trusted liaison to provider partners, responding to quality-related inquiries and facilitating collaborative discussions on improvement opportunities.

Performance Reporting & Data Management

• Partner with Quality Analytics and Business Intelligence to ensure timely, accurate, and meaningful quality performance reporting to internal teams and providers.
• Monitor performance trends and support the creation of dashboards, summaries, and progress reports for internal and external audiences.
• Maintain documentation, SOPs, and reporting schedules to support consistent quality operations.

Cross-Functional Collaboration & Strategic Support

• Collaborate closely with Provider Engagement, Contracting, Quality, and Clinical to ensure alignment on provider quality goals.
• Participate in cross-functional workgroups focused on quality improvement, network performance, and member and provider experience.
• Support strategic initiatives that promote continuous improvement and operational efficiency across the provider network.

Working Conditions

• Remote or hybrid working conditions. Position requires occasional travel in Massachusetts and the surrounding area.

Required Education:

• Bachelor's degree in healthcare administration, public health, business or health care related field

Desired Education:

• Master's degree
• Certified Professional in Healthcare Quality (CPHQ) or equivalent certification

Required Experience:

• 5-7 years of experience in healthcare quality improvement, provider network performance and management, population health, or related area
• Demonstrated experience interpreting and applying quality measures (HEDIS, CAHPS, HOS) and value-based contract performance metrics
• Experience with Medicare Advantage, Medicaid; and dually eligible populations

Desired Experience

• Experience managing or supporting pay-for-performance or value-based care programs.
• Experience leading provider education or training sessions.
• Exposure to health equity initiatives and/or CLAS standards integration in provider settings.

Required Knowledge, Skills & Abilities:

• Strong understanding of provider quality performance frameworks and value-based care principles.
• Working knowledge of claims data, quality measurement, and performance incentive methodologies.
• Excellent verbal and written communication skills, including the ability to synthesize and present data effectively to providers and internal stakeholders.
• Strong relationship management and interpersonal skills; ability to engage diverse provider partners diplomatically.
• Proficiency with Microsoft Office Suite (Excel, PowerPoint, Word) and comfort working with dashboards and analytics tools.
• Proven project management skills and ability to manage multiple priorities and deadlines.
• Self-directed, detail-oriented, and able to work effectively in a fast-paced, matrixed environment.

Desired Knowledge, Skills & Abilities:

• Familiarity with quality analytics platforms, provider portals, or data visualization tools.
• Working knowledge of health plan claims and payment policies, including provider reimbursement methodologies.
• Experience applying CLAS standards or health equity frameworks within provider engagement or quality improvement initiatives.

Language(s)

• English

Compensation Range/Target: $99,600 - $149,400

Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.