Commercial Program Manager in Palm Springs, Florida at PBACO Holding LLC

The Value-Based Agreement (VBA) Program Manager is responsible for overseeing the execution, performance, and ongoing optimization of value-based agreements across commercial, Medicare Advantage, and other payor partnerships. This role ensures that contractual requirements are met, operational workflows run smoothly, and performance outcomes support organizational financial and quality goals. The Program Manager collaborates directly with internal leadership, payor partners, clinical teams, analytics, finance, and operations to drive the success of assigned value-based care initiatives.

• Serve as a lead for payor expansion, including facilitation of rosters and scope-and-assess reviews
• Serve as a lead for assigned value-based agreements, ensuring efficient execution of all contract provisions
• Develop, maintain, and monitor program workflows, processes, and timelines supporting operational requirements
• Coordinate program readiness for new contracts, expansions, and renewals, including internal education and resource alignment
• Manage cross-functional integration between clinical, analytics, quality, finance, and contracting teams to support cohesive program delivery
• Monitor financial and quality performance for each VBA, identifying trends, gaps, and opportunities for improvement
• Partner with analytics teams to interpret performance dashboards, risk adjustment outcomes, utilization trends, and cost-of-care drivers
• Prepare regular performance reports, recommendations, and executive-level summaries
• Serve as a primary point of contact for payor partners on operational and programmatic matters
• Support facilitation of recurring payor meetings, joint operating committees, and escalation pathways
• Abide by all HIPAA, confidentiality, and privacy laws
• Perform other duties as assigned by Supervisors and Managers

To perform the job successfully, an individual should demonstrate the following competencies:

• Strong understanding of managed care contracting language and industry standards
• Strong understanding of VBC financial methodologies (shared savings, risk corridors, capitation, quality incentives, risk adjustment)
• Strong leadership skills, with the ability to motivate and manage cross-functional teams
• Strong analytical and problem-solving capabilities, with the ability to manage and interpret healthcare data
• Oral Communication — Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions
• Safety and Security — Uses equipment and materials properly
• Attendance/Punctuality — Is consistently at work and on time
• Knowledge of medical records work procedures
• Knowledge of computer applications
• Knowledge of medical terminology
• Knowledge of legal and ethical considerations related to patient information

• Achieve 100% compliance with all contractual terms
• Achieve roster submission deadline compliance for all programs
• Achieve year-over-year improvement in contract optimization
• Achieve 100% on-time delivery of appeal and grievance notifications to payors
• Identify and implement at least one new process improvement annually
• Complete at least one new payor opportunity assessment and contractual modeling annually
• Support execution of new VBAs annually and complete 100% of new payor onboarding requirements by stated deadlines

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• Bachelor's degree required; Master's degree in Healthcare Administration, Public Health, Business, Finance, or a related field preferred
• 3–7+ years of experience in value-based care, payor-provider partnerships, healthcare operations, population health, managed care, or ACO operations
• Experience managing complex multi-stakeholder healthcare programs strongly preferred
• Experience conducting managed care contracting language reviews strongly preferred
• Equivalent combination of education and experience considered