ABOUT MARINHEALTH
Are you looking for a place where you are empowered to bring innovation to reality? Join MarinHealth, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, an ever-expanding network of clinics, and a new state-of-the-art hospital, MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. We attract healthcare’s most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch.
MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others.
Company:
Prima Medical Foundation dba MarinHealth Medical Network
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
Job Description Summary:
The Population Health Program Manager guides and manages population health initiatives across MHMN ambulatory care practices to improve quality outcomes, close care gaps, optimize value-based care performance, and enhance patient access. This role serves as a part of the clinical quality leadership team and collaborates with clinical operations, physicians and APPs, care teams, payor partners, UCSF population health teams, MarinHealth Medical Center partners, and population health programs to lead initiatives ensuring patients receive timely, evidence-based care while meeting organizational and contractual quality goals.
Under the direction of the Director of Ambulatory Quality, and guidance of the Medical Director of quality and Ambulatory operational leadership team, the Population Health Program Manager contributes to the development and execution of strategies to improve preventive care, chronic disease management, risk adjustment performance, clinical outcomes for managed care patients, care coordination, and patient engagement. The position also plays a key role in training ambulatory staff and leaders, driving operational workflows, and integrating access management strategies that support quality, patient experience, and financial performance. The position helps to support the development and implementation of performance improvement plans and provide education to operational teams. The program manager would work with payers, UCSF population health, MarinHealth quality teams to develop relevant data analytics tools, dashboards for measurement of performance, and playbooks for implementing care redesign.
Job Requirements, Prerequisites and Essential Functions:
Pay Range:
$57.69 - $72.11 - $86.53
Essential Functions and Responsibilities:
Population Health & Care Gap Management
- Lead organization-wide efforts to identify, prioritize, and close care gaps across preventive, chronic disease, and wellness measures.
- Develop and implement workflows that improve performance on HEDIS, MIPs, CMS Star Ratings, quality metrics and incentives, and value-based care programs.
- Monitor care gap performance through dashboards and analytics tools.
- Partner with clinical staff members (including MDs, APPs, RNs, staff), clinic leaders, and care teams to improve outcomes such as for:
- Diabetes management
- Hypertension control
- Cancer screenings
- Immunizations
- Annual wellness visits
- Depression screening
- Chronic disease management programs
- HCC Coding, clinical documentation improvement
- Conduct root-cause analyses of performance opportunities and develop action plans for improvement.
- Develop action plans using PDSA and work to implement and educate clinical teams.
- Work with clinicians to provide care management support for managed populations.
- Lead outreach initiatives targeting high-risk, managed care/capitated, and underserved patient populations.
- Work with teams to establish reports, standard dashboards to track and trend performance and action plans.
Payor Partnership Management
- May serve as the operational lead for population health initiatives involving commercial, Medicare, Medicaid, and risk-based payor contracts.
- Build collaborative relationships with payor partners to align quality improvement strategies and performance expectations.
- Participate in regular joint operating reviews with health plans.
- Analyze quality scorecards and incentive opportunities across multiple payor contracts.
- Coordinate implementation of payor-sponsored care gap programs and member outreach campaigns.
- Ensure clinic teams understand payer-specific quality measures and reporting requirements.
- Monitor and communicate performance related to shared savings, quality incentives, and value-based reimbursement programs.
Access Management & Ambulatory Operations
- Partner with operational leaders to improve patient access and reduce barriers to care as it related to quality measures.
- Develop strategies to improve:
- Preventive care scheduling
- Follow-up appointment completion
- Care coordination access
- Referral management
- Annual wellness visit completion
- Collaborate with scheduling teams to create outreach campaigns for patients with open care gaps.
- Support implementation of access strategies that improve continuity of care and appointment utilization.
- Monitor no-show rates, cancellation trends, and scheduling effectiveness.
- Recommend operational changes that support both quality outcomes and access performance.
Education, Training & Change Management
- Design and deliver population health education programs for providers, leaders, care teams, referral coordinators, and scheduling staff.
- Train MHMN ambulatory teams on:
- Care gap closure workflows
- Quality measures and benchmarks
- Value-based care principles
- Population health tools and dashboards
- Risk adjustment documentation
- Access optimization strategies
- Develop standard work and educational materials to support sustainable performance improvement.
- Coach clinic leadership teams on population health performance management.
- Facilitate ongoing competency development related to quality and access initiatives.
- Utilize project management and performance improvement skills with focus on care management goals.
Data Analytics & Performance Improvement
- Analyze population health, quality, utilization, and access data to identify opportunities for improvement.
- Create actionable reports and executive-level summaries.
- Facilitate performance improvement projects using Lean, PDSA, DMAIC, or other improvement methodologies.
- Support established key performance indicators (KPIs) and monitor progress toward organizational goals.
- Present findings and recommendations to operational and physician leadership.
- Support strategic planning related to value-based care and population health initiatives.
Leadership & Collaboration
- Collaborate closely with providers, medical directors, clinic directors, care managers, referral teams, quality departments, and executive leadership.
- Foster a culture of accountability and continuous improvement.
- Lead multidisciplinary workgroups focused on quality, access, and patient outcomes.
- Represent ambulatory operations in organizational population health committees and payor meetings.
Qualifications:
Education:
- Bachelor's degree in Healthcare Administration, Nursing, Public Health, Business Administration, or related field required.
- Master's degree (MPH, MHA, MBA, MSN, or related field) preferred.
License & Certifications:
Experience:
- Minimum 5 years of progressive experience in ambulatory healthcare operations, population health, care management, quality improvement, or value-based care.
- Experience working directly with multiple health plan partners and quality programs.
- Experience leading operational or clinical improvement initiatives.
- Experience analyzing healthcare data and performance metrics.
Preferred Experience
- Experience with:
- Accountable Care Organizations (ACO)
- Care management
- Quality improvement standards, best practices
- Medicare Advantage
- Risk-based contracts
- Shared savings programs
- Primary Care and Specialty Care operations
- Access management initiatives
Knowledge, Skills & Abilities
- Strong understanding of population health management principles.
- Knowledge of HEDIS, Star Ratings, CMS quality measures, and value-based reimbursement models.
- Understanding of ambulatory clinic operations and patient access workflows.
- Advanced analytical and data interpretation skills.
- Strong project management and change management capabilities.
- Ability to influence clinical and operational leaders without direct authority.
- Excellent communication, presentation, and facilitation skills.
- Proficiency with electronic health records, registries, reporting tools, and population health platforms.
Key Performance Indicators
The Population Health Manager is accountable for measurable improvement in:
- Care gap closure rates
- Annual wellness visit completion
- HEDIS and Star measure performance
- Chronic disease outcome metrics
- Risk adjustment accuracy and completion
- Patient access metrics
- Third next available appointment
- Referral completion rates
- Preventive screening rates
- Value-based reimbursement performance
- Payor quality incentive achievement
- Staff training completion and competency
Accommodation:
Qualified applicants with disabilities may request reasonable accommodation during the application process by contacting Human Resources at 415-925-7040 or TalentAcquisition@mymarinhealth.org.
C.A.R.E.S. Standards:
MarinHealth seeks candidates ready to model our C.A.R.E.S. standards—Communication, Accountability, Respect, Excellence, Safety—which foster a healing, trust-based environment for patients and colleagues.
Health & Immunizations:
To protect employees, patients, and our community, MarinHealth requires measles, mumps, varicella, and annual influenza immunizations as a condition of employment (and annually thereafter). COVID-19 vaccination/booster remains strongly recommended. Medical or religious exemptions will be considered consistent with applicable law.
Compensation:
The posted pay range complies with applicable law and reflects what we reasonably expect to pay for this role. Individual pay is set by skills, experience, qualifications, and internal/market equity, consistent with MarinHealth’s compensation philosophy. Positions covered by collective bargaining agreements are governed by those agreements.
Equal Employment:
All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status, and any other classifications protected by federal, state, and local laws.
