Job Description

At Blue Zones Health we are redefining what it means to live a vibrant and healthy lifestyle. Inspired by long-living cultures around the world, we strive to empower people to make simple and sustainable lifestyle changes that lead to longer, better and more fulfilling lives. If you are ready to help transform well-being and be a pivotal part of our team, we want to meet with you!

This role combines strategic oversight of clinical care programs with high-impact quality improvement initiatives. The Program Manager (HEDIS/Quality) is responsible for driving performance across chronic care management, behavioral health integration, and value-based care outcomes. This role also champions provider engagement and continuous quality improvements (HEDIS) collaborating with both internal teams and external healthcare partners to enhance care delivery and patient outcomes.

The compensation range for this role is $85,000 - $95,000 depending on experience.

Key Responsibilities:

Clinical Program Leadership & Optimization

• Lead the strategy, development, and operational execution of chronic condition management, behavioral health integration, and complex care coordination programs.
• Implement standardized care pathways and digital health workflows (EHR, remote monitoring tools, apps) aligned with Blue Zones Health.
• Align care delivery models with value-based care objectives, including shared savings and risk-adjusted contracts.

Referral Management & Physician Support

• Ensure seamless Physician referrals into Blue Zones Health support programs.
• Develop Physician engagement strategies to improve referral volume and alignment with quality performance metrics and shared savings objectives.
• Work closely with marketing and provider outreach teams to ensure Blue Zones Health affiliate Physicians understand the impact, eligibility, and benefits of referring patients to programs.
• Maintain real-time feedback loops with providers through quarterly performance reviews, member progress reports, and collaborative care planning meetings.

Quality Improvement & Outcomes Management

• Oversee data improvement initiatives to optimize HEDIS performance across provider networks.
• Drive performance metrics for community and patient engagement.
• Serve as a subject matter expert on quality outcomes and measurement tools.

Cross-Functional & Provider Collaboration

• Partner with internal stakeholders, providers, and vendor teams to implement improvement actions and innovation strategies.
• Support and coach project managers across clinical and quality initiatives, ensuring delivery of results on time and within budget.
• Lead cross-functional team meetings and case reviews, promoting collaboration and issue resolution.

Compliance, Billing & Financial Alignment

• Ensure compliance with Medicare, Medicaid, and commercial payer regulations for CCM, BHI, and high-risk care programs.
• Collaborate with payer and IPA teams to optimize billing practices and capture performance-based revenue.
• Monitor audit readiness and conduct quarterly audits for quality assurance.

Change Management & Continuous Improvement

• Guide programs from pilot to implementation, embedding Lean methodology and continuous improvement principles.
• Lead change in dynamic, high-growth healthcare environments, building structure amid evolving models and expectations.

Qualifications

• Bachelor’s degree in healthcare, public health, or related field required; Master’s or clinical licensure (RN, NP, PA, LCSW) preferred.
• 7+ years of experience in healthcare program management, chronic care, or quality improvement.
• Demonstrated success in managing cross-functional teams and leading provider-facing initiatives.
• Expertise in HEDIS and value-based care strategies.
• Familiarity with digital health tools and remote care coordination platforms.
• Strong interpersonal, negotiation, and leadership skills with the ability to thrive in high-pressure, fast-paced environments.

For more information about Blue Zones Health , check us out at

Blue Zones Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, veteran status, or any other protected status under applicable law.

Job Tags

Similar Jobs