Upperline Health · 23 hours ago
Quality Program Manager- Medicare & ACO Programs
United States
Full-time
Remote
Senior Level
5+ years expUpperline Health is the nation’s largest provider group dedicated to lower extremity, wound and vascular care. The Quality Program Manager is responsible for overseeing, implementing, and optimizing quality performance initiatives for Medicare quality programs, ensuring regulatory compliance, and driving performance improvement across various teams.
HealthcareWellnessHospitalHealth CarePersonal Health
Responsibilities
Lead the planning, execution, and evaluation of Medicare quality programs, including CMS Star Ratings, HEDIS, CAHPS, and ACO quality measures
Serve as the subject matter expert on Medicare quality measurement methodologies, specifications, and annual changes
Translate CMS and NCQA requirements into actionable strategies for providers, care teams, and operational partners
Monitor quality performance against benchmarks, targets, and contractual requirements
Partner with analytics teams to develop and maintain dashboards, scorecards, and performance reports
Identify performance gaps and trends and recommend data-driven improvement strategies
Design and lead quality improvement projects to improve clinical outcomes, patient experience, and preventive care compliance
Support chart review, medical record retrieval, and supplemental data submission processes
Educate providers and staff on quality measures, documentation requirements, and performance improvement strategies
Facilitate quality committees, workgroups, and provider meetings
Support audits, validations, and data submissions related to Medicare quality programs
Stay current on changes to Medicare quality programs, industry trends, and best practices in value-based care
Qualification
Required
Bachelor's degree in healthcare administration, public health, nursing, or a related field
5+ years of experience in healthcare quality, population health, or value-based care
Demonstrated experience with CMS Star Ratings, HEDIS, and Medicare quality programs
Strong understanding of ACOs, Medicare Advantage, and value-based reimbursement models
Proven project management and cross-functional leadership skills
Experience working within an ACO, Medicare Advantage plan, or provider-sponsored health plan
Familiarity with quality analytics tools, EHR systems, and claims data
Preferred
Master's degree
Certification in healthcare quality or project management (e.g., CPHQ, PMP)
Benefits
Medical
Dental and vision
401K
PTO
Company
Upperline Health
Upperline Health has a variety of services to improve the lives of their patients.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$149.58MKey Investors
CrestlineSilversmith Capital Partners
2025-02-28Undisclosed· $12.22M
2023-06-07Private Equity· $58.35M
2023-05-09Private Equity· $28.35M
Leadership Team
David Thorpe
CEO
Matthew Pizzi
Chief Development Officer
Recent News
Upperline Health
2025-02-18
2025-02-18
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