Methodist Le Bonheur Healthcare · 5 hours ago
Clinical Quality & Payor Strategy Manager | FT | Weekdays
Memphis, TN
Full-time
Onsite
Senior Level
5+ years expMethodist Le Bonheur Healthcare is dedicated to caring for the community and impacting patients' lives. The Manager, Clinical Quality & Payor Strategy will lead strategic initiatives and operational execution for Medicare Advantage and value-based care programs, focusing on quality metrics and payer partnerships to enhance patient outcomes and ensure compliance with CMS models.
Health CareHealth DiagnosticsHospitalMedicalPersonal HealthWellness
Responsibilities
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
Qualification
Required
Associates Degree Healthcare Administration
Associates Degree Nursing
Associates Degree Public Health
Bachelor's Degree
High School Diploma or Equivalent
5-7 years Minimum of six (6) years of experience in Medicare and Value-Based Programs
Proven experience in people management and program management
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 planning, workflow development, and cross-functional coordination
Ability to monitor performance metrics and implement feedback loops for continuous improvement
Ability to manage multiple meetings and projects in a fast-paced environment
Excellent communication and stakeholder engagement skills across clinical, administrative, and external teams
Comfortable interpreting payor contracts and operationalizing requirements into scalable workflows
Proficient in managing multi-partner projects and navigating complex healthcare environment
Preferred
Experience with Epic EHR and population health tools
Company
Methodist Le Bonheur Healthcare
Methodist Le Bonheur Healthcare is a comprehensive network dedicated to enhancing the health and outcomes of patients.
10001+ employees
H1B Sponsorship
Methodist Le Bonheur Healthcare 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 (20)
2024 (3)
2023 (9)
2022 (15)
2021 (2)
2020 (4)
Funding
Current Stage
Late StageTotal Funding
$1MKey Investors
Health Resources and Services Administration
2021-07-01Grant· $1M
Leadership Team
Monica Wharton
Executive Vice President and Chief Operating Officer
Kate Dowd
SVP & Chief Legal Officer
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