Care Pathway Program Manager

Job Summary

The Care Pathway Program Manager is responsible for developing, implementing, and optimizing evidence-based care pathways across NCPS to promote consistent, high-quality care delivery throughout the patient care continuum. The role supports value-based care (VBC) initiatives and specialty programs by establishing the operational infrastructure, workflows, performance metrics, and reporting mechanisms necessary to achieve quality, utilization, and financial goals.

Job Specific Duties

• Compiles and analyzes performance metrics for the physician group, creates monthly reviews, and provides insights to leadership on operational efficiency, patient flow, and resource utilization.
• Prepares data for financial and operational systems and notifies managers of any outstanding items prior to meetings for accurate reporting.
• Tracks progress and addresses gaps in reports, working with providers to submit accurate data.
• Maintains and updates databases and spreadsheets for key performance indicators, ensuring completeness for reporting and analysis.
• Partners with clinical and operational teams to improve workflow efficiency and support quality improvement initiatives.
• Provides regular updates on performance metrics, insurance panel status, and HEDIS progress.
• Develops processes to close care gaps based on payer-goals and best practices.
• Assists with data collection, analysis, and reporting to meet quality of care indicators and other set KPIs on agreed-upon timelines.
• Liaison to external partners, managed care team, and other key stakeholders to ensure accurate and timely data, and process.

Qualifications

• Minimum Job Requirements: Bachelor's Degree in Healthcare Administration, Business Management, or related field; 2-4 years of experience with healthcare data analysis and interpretation; 2-4 years of experience with quality reporting programs, documentation standards and audit readiness; 2-4 years of experience in care coordination / case management activities; 2-4 years of experience with clinical documentation and panel work; 2-4 years of experience supporting pediatric quality measures.
• Minimum Qualifications: Bachelor's Degree in Healthcare Administration, Business Management, or related field; 2-4 years of experience with healthcare data analysis and interpretation; 2-4 years of experience with quality reporting programs, documentation standards and audit readiness; 2-4 years of experience in care coordination / case management activities; 2-4 years of experience with clinical documentation and panel work; 2-4 years of experience supporting pediatric quality measures.
• Preferred Qualifications: Master's degree (MHA, MPH, MSN, MBA); Proficiency in data management and analysis tools (Excel, SQL, or data visualization/reporting software); Knowledge of healthcare quality measures, including HEDIS; Familiarity with Electronic Health Records (EHR) systems and practice management software; Strong problem-solving and organizational skills, with excellent attention to detail; Excellent communication skills, able to present data to non-technical stakeholders; Experience with BI tools (e.g., Tableau, Power BI); Knowledge of CPT, ICD-10 codes, and clinical coding systems; Understanding of healthcare regulations and industry standards; Ability to work in a fast-paced environment; Ability to work collaboratively with clinical, operational, and administrative teams; Strong understanding of mandatory reporting requirements, incident management processes, and escalation protocols to ensure timely resolution of patient and workplace safety concerns; Quality improvement mindset with the ability to test, monitor, and continuously refine processes; Familiarity with payer portals and care management tools; Strong clinical documentation knowledge to support measure-compliant documentation; Strong foundation in pediatric care and common chronic conditions (e.g., asthma, ADHD, obesity, diabetes, developmental delays).