Summary

The Healthcare Clinical Transformation Manager is responsible for Value-Based Care (VBC) program implementation, provider performance management, coding accuracy, and the achievement of quality and financial outcomes. This individual works closely with the Medical Director and market leadership to execute strategic initiatives that improve quality metrics, patient outcomes, and operational performance. Key areas of focus include P4P and Episodes of Care performance, quality improvement initiatives such as the transition to in-office procedures and behavioral health integration, patient engagement, and other value-based care programs.

The Healthcare Clinical Transformation Manager is responsible for monitoring adherence to the Lifeline Quality, Coordination, and Accountability Initiative and other organizational quality programs, supporting performance improvement efforts, ensuring compliance with established requirements, and driving accountability across Care Centers. Through data analysis, provider engagement, chart audits, gap-in-care reviews, clinical documentation improvement, and performance monitoring, this role identifies and addresses barriers to high-quality care while supporting successful payer contract performance and organizational objectives.

Serving as a key liaison between clinical, operational, and administrative teams, the Healthcare Clinical Transformation Manager collaborates with market leaders to advance patient safety, utilization management, care coordination, and regulatory compliance initiatives. As an active member of the organization's quality committees, this position contributes to initiatives designed to enhance organizational performance, quality outcomes, and care delivery while fostering a culture of continuous improvement, accountability, safety, and patient-centered care.

Essential Functions

Responsible for the education, implementation, and ongoing optimization of clinical and Value-Based Care (VBC) programs, partnering with providers and leadership to achieve quality, patient experience, and financial performance goals.
Collaborate with providers, care center leadership, and interdisciplinary teams to identify performance improvement opportunities, influence provider behavior through education and coaching, and implement evidence-based practices that improve outcomes, reduce variation, and generate savings.
Lead provider engagement activities, including meetings, training sessions, and educational programs to support quality improvement, clinical documentation integrity, coding accuracy, and compliance with payer program requirements.
Monitor, analyze, and report on clinical, quality, utilization, and value-based care performance metrics; develop action plans to address gaps in care, improve outcomes, and support organizational and payer contract objectives.
Develop, maintain, and present provider scorecards, dashboards, performance reports, and leadership summaries that support data-driven decision-making, gap closure initiatives, and continuous improvement efforts.
Establish and maintain collaborative relationships with hospitals, providers, care centers, and market leaders to implement strategic initiatives, improve care coordination, and achieve quality performance goals.
Conduct chart audits, documentation reviews, clinical record evaluations, and data analyses to identify opportunities for quality improvement, clinical documentation enhancement, regulatory compliance, risk mitigation, and provider education.
Participate in Quality, Risk, Compliance, and Patient Safety Committees and contribute to initiatives designed to improve patient outcomes, organizational performance, accountability, and care delivery.
Monitor and review incident reports and patient safety events; conduct chart reviews, provider interviews, follow-up activities to identify trends, practice improvement opportunities, and educational needs, and support implementation of corrective actions.
Present quality, compliance, risk management, and patient safety findings to leadership committees and support the development and implementation of process improvements and targeted educational interventions.
Serve as a liaison between providers, organizational leadership, and medical malpractice carriers regarding precautionary reporting, high-risk clinical scenarios, case reviews, risk mitigation activities, and patient outreach programs, including PRESERVE.
Serve as the primary liaison between Care Centers, laboratory partners, and LabCorp to support quality metric performance, improve utilization, resolve operational issues, strengthen workflows, and promote effective collaboration and communication.
Monitor laboratory utilization and quality trends, partner with laboratory leadership to address service concerns, implement workflow improvements, and support initiatives that enhance clinical quality, operational efficiency, and patient outcomes.
Support payer contract performance through monitoring of quality benchmarks, utilization measures, risk adjustment initiatives, incentive program requirements, and value-based care metrics to maximize performance and shared savings opportunities.
Collaborate with market leadership to identify, prioritize, and execute clinical transformation, quality improvement, patient safety, and value-based care initiatives while ensuring compliance with organizational policies, regulatory requirements, and program expectations.

Qualifications

Effective communication and presentation skills.
Strong relationship building skills with clinical and non-clinical personnel.
Strong knowledge of the market.
Strong financial analytical background.
Knowledge base of clinical standards of care, and preventive health.
Strong critical thinking skills.
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills.

Pay: $160,000.00 - $165,000.00 per year

Benefits

401(k)
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Vision insurance

Education

Master's (Preferred)

Ability to Commute

Florham Park, NJ 07932 (Required)

Willingness to travel

25% (Preferred)

Work Location: In person

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Healthcare Clinical Transformation Manager

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Healthcare Clinical Transformation Manager