Director of Value-Based Programs

Job Summary

Leading a team focused on value-based programs, the full-time remote Director of Value-Based Programs will develop and implement strategies to enhance risk adjustment revenue and achieve financial objectives across various lines of business.

Key responsibilities

• Design and implement strategies to improve existing value-based initiatives and identify new opportunities for innovation
• Serve as the primary owner of value-based programs, managing contracts and collaborating with health plan leadership to achieve program goals
• Hire, train, and evaluate team performance while fostering a high-performance culture dedicated to best-in-class solutions

Required qualifications

• At least 8 years of managed care experience, including value-based programs, or equivalent education and experience
• Minimum of 3 years in management/leadership roles with experience in Medicaid, Medicare, or Marketplace program design and implementation
• Knowledge of value-based programs, risk adjustment models, and quality metrics such as HEDIS and Medicare STARS
• Strong understanding of medical economics and financial reporting, with the ability to guide stakeholders through complex reconciliations
• Proven ability to innovate and manage complex processes within a highly matrixed organization