Program Manager – Provider Engagement, Risk Adjustment & Quality Performance

JOB DESCRIPTION

Job Summary

The Program Manager – Provider Engagement plays a key role in driving risk adjustment and quality performance outcomes through effective program management, operational execution, and provider engagement support. This role is responsible for overseeing program workflows, developing SOPs, coordinating cross-functional teams, and ensuring timely execution of deliverables to support health plan goals. The Program Manager ensures providers and partners receive accurate information, program updates, and actionable insights to improve healthcare outcomes and organizational performance.

 

Key Responsibilities

1. SOP & Documentation Development

• Develop, review, and update Standard Operating Procedures (SOPs) for risk adjustment and quality program workflows.
• Maintain accurate, up-to-date documentation of processes, timelines, and responsibilities to support consistency and compliance.

2. Program Planning & Coordination

• Support the planning and execution of new program requirements across risk and quality initiatives.
• Coordinate with cross-functional teams (analytics, reporting, IT, provider engagement, quality, operations) to ensure seamless delivery.
• Manage scheduling, agenda preparation, and meeting follow-ups to drive accountability and alignment.

3. Operational Support

• Oversee target list management, form deployment, and provider submissions.
• Track targets, ensure jobs run on time, and validate outputs for accuracy and completeness.
• Follow up with IT teams on execution status, system performance, and error resolution.

4. Reporting & Monitoring

• Review and consolidate performance reports to support leadership decision-making.
• Partner with analytics teams to troubleshoot reporting issues and ensure data integrity.
• Anticipated expansion into tracking & provider scorecards to support program.

5. Provider & Health Plan Engagement Support

• Draft communication templates, talking points, and guidelines for external stakeholders.
• Provide responsive support to provider and partner inquiries, ensuring consistent and timely information sharing.

6. Process Improvement

• Identify workflow gaps and recommend process enhancements for efficiency and scalability.
• Streamline tracker update processes and maintain centralized documentation repositories (SharePoint/OneDrive).

7. Cross-Functional Collaboration

• Act as a liaison across teams to ensure timely communication of program updates and deliverables.
• Provide backup coverage for critical program tasks and maintain business continuity.

Job Duties

• Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.
• Plans and directs schedules as well as project budgets.
• Monitors the project from inception through delivery.
• May engage and oversee the work of external vendors.
• Focuses on process improvement, organizational change management, program management and other processes relative to the business.
• Leads and manages team in planning and executing business programs.
• Serves as the subject matter expert in the functional area and leads programs to meet critical needs.
• Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.
• Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
• Generate and distribute standard reports on schedule

 

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Bachelor's Degree or equivalent combination of education and experience.

 

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3–5 years of program/project management or healthcare operations experience.
• Strong documentation, SOP writing, and process mapping skills.
• Excellent written and verbal communication skills.
• Expected advanced proficiency in Microsoft Excel, PowerPoint, Word, and SharePoint.
• Experience validating operational outputs