Manager, Value-Based Programs

Position Summary

Summit Medical Consultants (SMC) is seeking an experienced healthcare professional to serve as Manager of Value-Based Programs. This position is responsible for coordinating and optimizing all initiatives related to Accountable Care Organizations (ACO), Merit-Based Incentive Payment System (MIPS), Pay-for-Performance (P4P), and Institutional Special Needs Plans (I-SNP).

This individual will serve as the operational lead for all value-based efforts—driving quality improvement, enhancing Star Ratings, and maximizing the organization's financial performance within risk-sharing and bonus-based arrangements. The ideal candidate thrives at the intersection of data, operations, and clinical collaboration.

Key Responsibilities

Program Management & Execution

• Coordinate the implementation and daily management of SMC's ACO, MIPS, P4P, and I-SNP programs.
• Develop annual performance targets aligned with payer metrics, quality measures, and bonus opportunities.
• Oversee data collection, validation, and submission processes to ensure compliance with CMS and commercial program requirements.
• Collaborate with leadership to identify and prioritize high-impact initiatives that drive performance improvement.

Performance Monitoring & Reporting

• Build and maintain tracking dashboards to monitor clinical quality, utilization, and cost outcomes.
• Translate data into actionable insights and develop targeted improvement plans with key stakeholders.
• Present monthly and quarterly reports to leadership on quality metrics, RAF scores, Star Ratings, and bonus attainment status.
• Partner with the data analytics team to ensure accurate reporting and continuous improvement.

Provider & Team Engagement

• Support provider education and engagement initiatives related to MIPS measures, risk adjustment documentation, and care coordination best practices.
• Serve as liaison between clinical teams, operations, and revenue cycle to ensure alignment with value-based goals.
• Facilitate performance feedback sessions with medical directors and practice leadership.

Continuous Improvement & Compliance

• Stay current with CMS rule changes, Star Rating methodology updates, and ACO benchmark adjustments.
• Identify workflow improvement opportunities to streamline documentation, coding, and data capture processes.
• Ensure full compliance with payer reporting timelines and internal quality management standards.

Qualifications

• Bachelor's degree required, Master's degree in Healthcare Administration, Public Health, Business, or related field preferred.
• Minimum of 5 years' experience in healthcare quality, population health, or value-based program management.
• Demonstrated success supporting or managing ACO, MIPS, or P4P initiatives.
• Strong working knowledge of CMS reporting standards, RAF scoring, and Star Rating systems.
• Proficiency in Microsoft Excel, Power BI, or similar analytics platforms.
• Exceptional communication, presentation, and relationship-building skills.
• RN, LPN, or clinical background preferred but not required.

Performance Metrics

• Percentage of achieved bonus vs. potential (ACO, MIPS, or P4P).
• Year-over-year improvement in Star Ratings and quality scores.
• Timeliness and accuracy of payer submissions.
• Provider participation and documentation compliance rates.

Bonus Plan

The Manager of Value-Based Programs will be eligible for an annual performance bonus up to 10–15% of base salary. The bonus is directly tied to measurable outcomes in the value-based portfolio.

Performance is reviewed annually and calculated based on validated payer reports and SMC's internal KPI dashboard results.

Career Growth

As SMC expands its value-based care portfolio, this position may evolve into a director-level role with broader strategic and financial accountability, including oversight of dedicated analysts or coordinators.

Job Type: Full-time

Pay: $105, $125,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Paid time off
• Vision insurance

Application Question(s):

• Will you now or in the future ask Summit Medical to commence an immigration case to employ you (e.g., H-1B or other employment-based immigration case)? This is sometimes called "sponsorship" for an employment-based visa status.

Ability to Commute:

• Greenwood Village, CO Required)

Work Location: In person