Manager- Market Performance & Improvement

Manager- Market Performance & Improvement

The Manager of Market Performance & Improvement serves as a strategic leader and subject matter expert responsible for overseeing the operational and financial performance of the Medicare product across all markets. This role is accountable for establishing and maintaining high performance in key areas including Star/Quality Ratings, risk adjustment, utilization management, and unit cost. The Manager exercises independent judgment and discretion in evaluating market-level performance, identifying systemic gaps, and leading the design and execution of multi-faceted improvement strategies that align with organizational and value-based care objectives. Working cross-functionally with providers, clinical teams, network partners, and ACO leadership, this role influences decision-making, manages large-scale projects, and ensures the effective adoption of quality, financial, and operational performance improvement strategies across multiple markets.

What You'll Do

• Provider Performance Monitoring & Engagement
  • Monitor overall provider performance utilizing performance reports including quality, utilization, referral management, and risk, as well as provider engagement activities and team feedback.
  • Use data insights to prioritize provider engagements and determine the most effective intervention strategies based on performance outcomes and business impact.
  • Develop provider profiles and insights to identify key areas in workflows that can be improved, including AWV processes, EMR template design, and scheduling practices. Risk Adjustment & HCC Improvement
  • Understand, develop, and implement HCC (Hierarchical Condition Category) improvement activities to support accurate risk adjustment and financial performance.
  • Implement provider change management activities, including organizing and structuring provider education sessions and developing tools to enhance clinical documentation and coding accuracy.
  • Align in-office activities to support HCC capture and ensure optimal risk adjustment performance across the provider network.
• Quality Improvement & Program Development
  • Understand, develop, and implement quality improvement activities such as colorectal screening programs, education webinars, EMR improvement initiatives, and medication management programs (e.g., pill delivery programs).
  • Align quality improvement efforts through market vendors and internal stakeholders to ensure coordinated execution across the network.
  • Lead provider education and engagement strategies designed to improve HEDIS, Stars, and other quality performance metrics.
• Data Analysis & Performance Reporting
  • Analyze claims data, performance reports, and utilization reports using Excel and available technology platforms to identify trends and performance opportunities.
  • Translate complex data insights into actionable performance improvement strategies tailored to individual markets and provider needs.
  • Monitor progress against established goals and adjust strategies as needed to ensure performance targets are achieved.
• Network Development, Provider Relations & Market Growth
  • Use data to identify and establish relationships with key specialty groups to improve patient care and lower cost.
  • Establish Joint Operating Committees (JOCs) with network partners to identify opportunities for improvement through data analysis and referral management with PCPs.
  • Serve as a key liaison between provider practices and organizational leadership to escalate risks, share insights, and drive strategic alignment.
  • Lead network and provider growth initiatives aligned with market expansion priorities, identifying and onboarding new provider partners to strengthen Astrana's value-based care network.
  • Collaborate with Market Operations and network development teams to assess geographic gaps, evaluate provider opportunities, and execute strategies that expand market presence and increase attributed patient populations.
  • Support the integration of newly onboarded providers into performance improvement programs, ensuring alignment with quality, utilization, and financial goals from the point of engagement.
• Goal Setting & Cross-Functional Leadership
  • Develop long-term and short-term goals with tracking metrics; establish role-based goals that align with Astrana organizational objectives.
  • Work with team members to identify key activities that directly impact entity goals, and collaborate with ACO management to set specific performance targets for quality or financial improvement.
  • Partner with internal stakeholders across Market Operations, Quality, and Population Health to ensure alignment on performance improvement initiatives.
  • Manage multiple large, cross-functional projects simultaneously, ensuring timely delivery and measurable impact.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field, or equivalent combination of education and progressively responsible experience.
• Master's degree preferred.
• 5+ years of product performance management experience, including both quantitative and qualitative performance measures.
• Experience in value-based care, market performance management, or quality improvement initiatives preferred.
• Demonstrated experience analyzing performance data and developing actionable, data-driven strategies.
• Experience working directly with provider groups, physicians, or clinical teams preferred.
• Project Management Professional (PMP) certification preferred.
• Clinical Licensure (RN, LVN, or equivalent) preferred.
• Certified Professional in Healthcare Quality (CPHQ), Lean/Six Sigma (Green or Black Belt), or related certification preferred.
• Demonstrated ability to exercise independent judgment and discretion in evaluating performance data and recommending business-critical solutions.
• Strong understanding of value-based care models, Medicare product performance, risk adjustment, and healthcare quality improvement methodologies.
• Advanced analytical skills with the ability to interpret complex datasets and translate findings into actionable strategies.
• Strong business and financial acumen, including understanding of quality metrics, cost drivers, utilization management, and performance incentives.
• Ability to influence provider behavior and drive change through consultative and relationship-based approaches.
• Excellent communication and presentation skills, with the ability to engage physicians, care teams, and executive leadership.
• Strong project management skills with the ability to manage multiple high-impact initiatives simultaneously.
• Proficiency in Excel, data analytics tools, and healthcare data platforms.
• Ability to work independently in a dynamic, fast-paced, multi-market environment.

Environmental Job Requirements and Working Conditions

• This role operates in a hybrid environment supporting multiple markets across Astrana's value-based care network within Maryland, Virginia and Washington DC. The Manager of Market Performance & Improvement is expected to independently plan and prioritize engagements with provider practices, clinical teams, network partners, and ACO leadership to drive clinical and operational performance improvement. The position may require periodic travel to market locations to conduct onsite assessments, facilitate provider meetings, and support implementation of performance improvement strategies. Travel expectations will vary based on market needs and organizational priorities. The Company reserves the right to modify the work arrangement, including travel expectations or transitioning the role to a more onsite-based structure, based on business needs and operational priorities.
• The total compensation target pay range for this role is: $115,000 to $125,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

About Astrana Health, Inc.

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare