Commonwealth Care Alliance · 10 hours ago
Provider Network Quality Strategy Program Manager
Boston, MA
Full-time
Hybrid
Mid, Senior Level
$100K/yr - $149K/yr
5+ years expCommonwealth Care Alliance is focused on advancing provider quality performance across its contracted network. The Program Manager will manage and implement key population health and network quality initiatives to achieve high performance on CCA's Population Health goals, collaborating with various teams to drive improvement in clinical outcomes and member experience.
Health CareHospitalMedical
Responsibilities
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
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
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
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
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
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
Qualification
Required
Bachelor's degree in healthcare administration, public health, business or health care related field
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
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
Preferred
Master's degree
Certified Professional in Healthcare Quality (CPHQ) or equivalent certification
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
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
Benefits
You may qualify for a bonus tied to company and individual performance
Substantial and comprehensive total rewards package
Company
Commonwealth Care Alliance
Commonwealth Care Alliance is an integrated care system that advocates for economical healthcare policies.
1001-5000 employees
H1B Sponsorship
Commonwealth Care Alliance has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (16)
2023 (11)
2022 (18)
2021 (21)
2020 (15)
Funding
Current Stage
Late StageTotal Funding
$1.77MKey Investors
The Robert Wood Johnson Foundation
2025-04-09Acquired
2019-11-11Grant· $1.77M
Leadership Team
Amanda Cassel Kraft
Chief Operating Officer
Don Stiffler
Chief Revenue and Growth Officer
Recent News
2025-12-29
Press Telegram
2025-12-03
Company data provided by crunchbase