Director of Value Based Care

Overview of the Position:

The Director of Value-Based Care is responsible for the strategic development, operational management, and financial performance of value-based care (VBC) initiatives across the organization. This role oversees payer incentive programs, shared savings arrangements, population health initiatives, and quality performance strategies related to Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), Medicare Advantage plans, UDS Clinical Quality Measures, and other payer contracts.

The Director will lead organizational efforts focused on risk adjustment, quality improvement, care coordination, utilization management, and shared savings optimization while ensuring compliance with payer and regulatory requirements. This position also provides leadership for Value-Based Care Coordinators and collaborates closely with clinical, operational, finance, coding, quality, and analytics teams to improve patient outcomes and maximize organizational performance.

Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Business Administration, Public Health, or related field required.
• Master's degree preferred.
• Minimum of 5 years of experience in value-based care, population health, managed care, healthcare operations, quality improvement, or related healthcare leadership role.
• Experience with payer incentive programs, shared savings arrangements, risk adjustment, and quality initiatives required.
• Experience with Medicare Advantage, ACOs, MCOs, and FQHC quality reporting preferred.
• Leadership or supervisory experience preferred.

Skills and Abilities

Strong understanding of:

• Value-based reimbursement models
• Risk adjustment/HCC coding
• UDS Clinical Quality Measures
• Medicare Advantage and ACO performance measures
• Strong analytical and problem-solving skills with the ability to interpret healthcare data and performance metrics.
• Advanced proficiency in Microsoft Excel and experience working with healthcare reporting and analytics tools.

Position Responsibilities

Value-Based Care Strategy

• Lead the development, implementation, and optimization of value-based care initiatives and population health strategies.
• Manage payer incentives and shared savings programs including MCOs, ACOs, Medicare Advantage, and other payer contracts.
• Monitor organizational performance related to quality and shared savings benchmarks.
• Identify opportunities to improve patient outcomes, reduce avoidable overutilization, and maximize payer incentives and shared savings.
• Collaborate with payer partners and internal leadership regarding contract performance and reporting requirements.

Quality Improvement & Population Health

• Lead organizational quality improvement initiatives related to preventive care, chronic disease management, care gap closure, and population health outcomes.
• Oversee performance related to UDS Clinical Quality Measures and other payer quality programs.
• Monitor quality dashboards, reports, and trends to identify opportunities for operational and clinical improvement.
• Support provider engagement and accountability related to quality and performance initiatives.

Risk Adjustment & Coding

• Oversee risk adjustment, risk stratification, and coding accuracy initiatives to support compliant documentation and payer reporting requirements.
• Lead provider attestation efforts and collaborate with EMR and clinical teams to improve documentation integrity and HCC capture.
• Monitor trends and opportunities related to coding accuracy and risk adjustment performance.

Care Coordination & Program Oversight

• Manage and oversee Value-Based Care Coordinators and related staff.
• Lead initiatives focused on:
• Hospital Follow-Up (HFU)
• Annual Wellness Visits (AWV)
• Transitional Care Management
• Care coordination and patient outreach

Leadership & Collaboration

• Serve as a strategic leader and subject matter expert for value-based care initiatives across the organization.
• Collaborate with providers, operations, finance, quality, coding, and executive leadership teams to support organizational goals.
• Provide education and guidance related to value-based care, quality performance, and payer expectations.

Physical Requirements:

Must be able to lift 30 pounds. Vision and hearing corrected to within normal limits is required. Must have manual dexterity to key in data; utilize computer, grab, grip, hold, tear, cut, sort, and reach.