Clinical Quality & Payor Strategy Manager | FT | Weekdays

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
 

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
 

The Manager, Clinical Quality & Payor Strategy is responsible for leading strategic initiatives and operational execution across multiple Medicare Advantage and value-based care programs. This role serves as a subject matter expert in quality metrics, electronic health record workflows, and payer partnerships, driving performance improvement and alignment with organizational goals. The manager collaborates with internal teams, external partners, and payors to optimize care delivery, enhance patient outcomes, and ensure compliance with CMS-aligned models. This includes translating payor requirements into actionable workflows, monitoring performance and visit compliance, and implementing feedback loops that support continuous improvement. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

 

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
The Manager, Clinical Quality & Payor Strategy is responsible for leading strategic initiatives and operational execution across multiple Medicare Advantage and value-based care programs. This role serves as a subject matter expert in quality metrics, electronic health record workflows, and payer partnerships, driving performance improvement and alignment with organizational goals. The manager collaborates with internal teams, external partners, and payors to optimize care delivery, enhance patient outcomes, and ensure compliance with CMS-aligned models. This includes translating payor requirements into actionable workflows, monitoring performance and visit compliance, and implementing feedback loops that support continuous improvement. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Leads strategic planning and execution of value-based quality initiatives across multiple Medicare Advantage payors.
• Serves as subject matter expert for internal quality metrics and EHR workflows, providing education, troubleshooting, and optimization support.
• Develops and manages operational workflows for strategic programs including UHC Fastpass, MdRev, FindHelp, and Aledade, ensuring alignment with organizational goals.
• Coordinates with external partners and internal stakeholders to expand services, improve care delivery, and support program growth.
• Facilitates quality governance by organizing committee meetings, preparing agendas, and presenting updates.
• Provides strategic and operational support to Population Health teams, including clinical staff and program managers.
• Monitors compliance with payor-specific visit requirements and documentation standards, ensuring alignment with CMS and contract expectations.
• Implements performance tracking and feedback mechanisms to support continuous improvement across clinics and teams.
• Collaborates with IT and clinical teams to optimize EHR workflows that support care gap closure and quality reporting.
• Represents the organization in meetings with ACOs and Medicare Advantage payors to drive performance and strategic alignment.

Education/Formal Training Requirements

• Required - Associates Degree Healthcare Administration
• Preferred - Associates Degree Nursing
• Preferred - Associates Degree Public Health
• Preferred - Bachelor's Degree
• Preferred - High School Diploma or Equivalent

Work Experience Requirements

• Required - 5-7 years Minimum of six (6) years of experience in Medicare and Value-Based Programs
• Required - Proven experience in people management and program management
• Preferred - Experience with Epic EHR and population health tools
• Preferred - Substitutions allowed: In lieu of a Associate’s degree, the candidate must have a high school diploma with eight (8) years of direct clinical care coordination or social work

Knowledge, Skills and Abilities

• Familiarity with Medicare Advantage payors, ACO structures, and CMS-aligned quality frameworks.
• Strong understanding of Medicare Advantage, value-based care models, and payor incentive structures.
• Knowledge of compliance standards for patient visits, documentation, and quality reporting.
• Skilled in strategic planni