Director, Value-Based Care Job at Carex Consulting Group (New York City)

Director, Value-Based Analytics & Actuarial Strategy

SpectraMedix is seeking an accomplished professional with an actuarial or advanc...

Location

United States , NJ

Salary:

Not provided

SpectraMedix

Expiration Date

Until further notice

Requirements

Bachelor’s or Master’s degree in Actuarial Science, Statistics, Mathematics, Health Economics, or related field
12+ years of experience in actuarial, financial, or value-based analytics roles within a consulting firm, health plan, ACO, or healthcare analytics organization
Proven understanding of value-based contracting, risk adjustment, quality metrics, and payment reconciliation processes
Strong data literacy—experience working with healthcare data (claims, cost, quality, utilization) and proficiency with analytical tools (SQL, R, Python, Excel, Power BI, etc.)
Excellent communication skills with the ability to engage payer and provider executives and translate complex analytics into actionable strategy
This role involves approximately 20–25% travel, so you should be comfortable with occasional work-related travel
Hands-on exposure to Cloud technologies, particularly Azure, AWS, and Databricks

Job Responsibility

Partner with health plans, ACOs, and health systems to design, evaluate, and enhance value-based care programs (e.g., shared savings, global capitation, incentive models)
Lead actuarial and financial analytics supporting contract modeling, risk adjustment, benchmarking, and performance measurement across multiple lines of business (Medicaid, Medicare, Commercial)
Translate analytical findings into strategic insights for clients—supporting contract development, performance improvement, and program optimization
Collaborate with internal teams (product, engineering, and client delivery) to shape product strategy and ensure that data-driven capabilities align with evolving market needs
Serve as a client-facing subject matter expert in value-based contracting, risk modeling, and performance analytics
Assist clients with defining their value-based strategy and defining an ROI
Contribute to business development activities by supporting client presentations, proposals, and thought leadership initiatives
Stay current with CMS, state Medicaid, and commercial VBP policy trends, including interoperability and quality measurement standards (HEDIS, eCQMs, DaVinci, MCP, etc.)
Be a strategic thought leader within the Company to help scale SpectraMedix into the leader in VBC software applications

What we offer

Competitive compensation, benefits, and professional growth opportunities

Associate Director, Value Assessment – Independent Physician Associations Vaccines- US WEST

Join the team protecting half a billion lives every year with next-gen science, ...

Location

United States , Remote

Salary:

148500.00 - 214500.00 USD / Year

Sanofi

Expiration Date

Until further notice

Requirements

Bachelor's degree required
5+ years of experience in market access, payer engagement, or health economics related function (Vaccines a plus)
Must have experience navigating health systems and Independent Physician Associations or other risk-bearing entities
Vast understanding of commercial payer reimbursement and risk-barring methodology
Financial experience, vaccines understanding
Strong understanding of financial analysis/economic modeling
Attention to building and maintaining customer relationships to achieve success
Demonstrates Executive Presence in all types of interactions, boardrooms, in-person & remote
Collaborates across functional, geographic, and company boundaries to meet mutual business objectives
Continually focuses on the performance and development of oneself and others to enhance the talent of the company

Job Responsibility

Engage with C-suite level decision makers across Risk-based organizations (RBO) and Independent Physician Associations the use of Sanofi portfolio
Maximize the understanding of the economic value of Sanofi Vaccines products and demonstrate the clinical and economic value to customers in a compelling way according to their financial, quality and clinical objectives
Develop and update targeting and profiling in the assigned geography
Identify the optimal IPAs and RBOs with the highest probability of success of engagement
Map key decision makers within the IPAs and RBOs, noting any overlaps with other Sanofi customers or providers
Continuously assess trends in risk-based contracting and alternative payment models that influence opportunities within IPAs and similar entities
Identify strategy and tactics to payers when appropriate
Develop engagement strategy and tactics based on sound rational using available data sources, the collective intelligence of cross-functional teams and learnings from external sources
Document and share insights from IPA and RBO engagements to help inform Sanofi’s broader Market Access strategy
Contribute to refining the value proposition for the different types of RBOs, including IPAs, shifting conversations from cost only to health economics analysis, models, budget impact models, reimbursement arguments and clinical efficacy

What we offer

Company car through the Company’s FLEET program
Wide range of health and wellbeing benefits including high-quality healthcare, prevention and wellness programs
At least 14 weeks’ gender-neutral parental leave

Fulltime

Director, Cost of Care Performance

At Pearl Health, you’ll help redefine how primary care succeeds in value-based c...

Location

United States , Seattle; New York City; Boston

Salary:

150000.00 - 195000.00 USD / Year

Pearl Health

Expiration Date

Until further notice

Requirements

Bachelor’s degree required
advanced degree (MHA, MBA, MPH, or related) preferred
8+ years of experience in healthcare operations, value-based care, or health plan management
5+ years of leadership experience managing cross-functional teams and high-impact initiatives
Deep understanding of total cost of care, utilization management, and value-based care models
Proven success translating analytical insights into operational strategy and measurable results
Experience with Medicare and/or Medicaid programs, including CMS regulations and CMMI models
Demonstrated experience managing vendors and external partnerships to drive performance
Strong communication and stakeholder management skills across clinical, technical, and business teams

Job Responsibility

Drive the roadmap for operational programs and partnerships that reduce unnecessary spend and utilization and improve care delivery across Pearl’s provider network
Partner with Data Science, Product, and Customer Success to size and prioritize strategic opportunities that impact total cost of care
Translate insights into scalable operational tactics that improve patient outcomes, decrease wasteful spending, and enhance provider experience
Lead efforts to identify, investigate, and mitigate fraud, waste, and abuse (FWA)
Develop and manage strategic vendor partnerships that advance Pearl’s total cost of care and utilization management objectives
Partner with Product and Growth teams to transform provider feedback and market learnings into product enhancements and operational improvements
Collaborate with Customer Success to design, roll out, and optimize provider incentive and engagement programs
Champion provider education through clear communication materials, guides, and training sessions that support success in value-based care models

What we offer

Eligible for a discretionary performance bonus and equity options
competitive benefits package

Fulltime

Lead Director, Network Management

We're building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

100000.00 - 231540.00 USD / Year

CVS Health

Expiration Date

June 27, 2026

Requirements

A minimum of 10 years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems
Demonstrated experience in Medicaid provider contracting, including negotiating, executing, and managing agreements with hospitals, physician groups, and ancillary providers
Hands-on experience with Behavioral Health (BH) network development and contracting, including providers across inpatient, outpatient, and community-based settings
Proven ability to manage the end-to-end contracting lifecycle (negotiation, redlining, implementation, and ongoing relationship management)
Strong knowledge of Medicaid regulations, state requirements, and network adequacy standards, with the ability to ensure compliance across market
Experience developing or supporting value-based arrangements and reimbursement models within Medicaid and Behavioral Health populations
Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals
Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs

Job Responsibility

Developing strategic partnerships for the Kentucky Medicaid Health Plan
Designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups
Maintaining and enhancing provider networks
Building strong relationships with providers
Developing and executing contract strategies
Negotiating and managing various value based payment models and management of contract performance
Recruiting providers as needed to ensure attainment of network expansion and adequacy targets
Identifying and managing cost issues
Collaborating cross functionally to execute significant cost saving initiatives
Promoting collaboration with internal partners

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Bonus, commission or short-term incentive program
Equity award program

Fulltime

Sr. Sales Executive - Consulting Services - State Medicaid

NTT DATA Services Public Sector Vertical is currently looking for a Sr. Sales Ex...

Location

United States , Plano

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

15+ years of experience supporting government clients, including State Medicaid
10+ years of selling professional services State Medicaid agencies/departments
Demonstrated success closing multi-million-dollar, multi-year consulting engagements
Strong knowledge of public-sector procurement and contracting
Proven ability to operate in long, complex sales cycles
Bachelor's degree required

Job Responsibility

Identify emerging agency needs related to: Medicaid Enterprise Systems (MES/MMIS)
Eligibility & Enrollment
Managed Care and Value-Based Care
Program integrity, analytics, and compliance
CMS initiatives, waivers, and APD-funded programs
Market-maker who originates deals proactively
Subject Matter Expert in Medicaid
Build and maintain trusted relationships with: Medicaid Directors and Deputy Directors
State CIO/CTO and Medicaid IT leadership
Program, finance, and policy leaders within Health and Human Services agencies

Fulltime

Senior Director, AI Business Solutions Leader (Healthcare)

The Senior Director, AI Business Solutions Leader (Healthcare) oversees the team...

Location

United States , Multiple Locations

Salary:

155800.00 - 277200.00 USD / Year

Microsoft Corporation

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Computer Science, Information Technology, Engineering, Business, Liberal Arts, or related field AND 10+ years experience in cloud/infrastructure technologies, information technology (IT) consulting/support, software development/support, technology solutions, practice development, architecture, and/or consulting OR equivalent experience
5+ years people management experience, including managing consultant practice managers, technical sales managers, technical architect managers, and/or people managers
This position is not eligible for visa sponsorship. Candidates must have authorization to work in the United States that does not now or in the future require employer sponsorship
Bachelor's Degree in Computer Science, Information Technology, Engineering, Business, Liberal Arts, or related field AND 15+ years experience in cloud/infrastructure technologies, information technology (IT) consulting/support, software development/support, technology solutions, practice development, architecture, and/or consulting OR Master's Degree in Computer Science, Information Technology, Engineering, Business, Liberal Arts, or related field AND 12+ years experience in cloud/infrastructure technologies, technology solutions, practice development, architecture, and/or consulting OR equivalent experience
8+ years experience working in a customer-facing role (e.g., internal and/or external)
8+ years experience leading technical projects, teams, or functions
Technical Certification in Cloud (e.g., Azure, Amazon Web Services, Google, security certifications)
8+ years people management experience, including managing consultant practice managers, technical sales managers, technical architect managers, and/or people managers
Health and Life Sciences industry experience

Job Responsibility

Holds team accountable for driving operational excellence and proven practice standards throughout all sales stages/activities/tools of record (e.g., pipeline updates, time tracking)
Drives team on orchestrating, collaborating, and influencing across Microsoft and customer/partner teams and leadership through on-strategy delivery to achieve customer/partner objectives and increase customer/partner satisfaction
Holds team accountable for anticipating and managing business and technical risks, adapting methodology and applying governance principles to identify, communicate, and minimize business and technical risks
Executes work in compliance with industry and Microsoft guidelines and procedures
Oversees continuous prioritization among competing demands in their work and identify where impact occurs with customers, ensuring alignment with business priorities and goals
Drives team on proactively identifying, anticipating, and setting the foundation with the customer/partner for new cross-solution opportunities for Consumption, Usage & Unified expansion (especially Enhanced Solutions) at scale based on business value to customer/partner and clear understanding of the Microsoft value proposition for supported platforms to empower cloud success, foster and strengthen security and resiliency, and drive AI innovation
Defines the need for change management to ensure team members develop thorough understanding of customer's business and operations to advise on potential solutions
Drives team on acting as a role model for strategically consulting with, actively listening to and respectfully challenging customers/partners, building trust to then advocate for alternative architectures/solutions/approaches that shape and/or enhance customer requirements
Oversees team on driving the identification, anticipation, and evaluation of industry trends (e.g., customer industry verticals, information technology [IT] industry), gathering of customer/partner insights (e.g., feedback around technical preferences, environments, business needs, competitive landscape), and mapping of both existing and novel architecture and digital transformation solutions to customer/partner business outcomes
Holds teams accountable for capturing opportunities in appropriate systems, processes, and tools, working collaboratively across the organization to execute on opportunities

Fulltime

Care Center Manager II - Phoenix/Avondale

Care Center Manager role is part of a team-based approach in providing advanced ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

High School Diploma
3 years in healthcare management directly serving patients
BLS Certification required within 30 days of hire
Excellent patient or customer service and communication skills
Proficient PC skills

Job Responsibility

Under the direction of the Director of Operations, and in partnership with the Care Center lead physician and the executive leadership team, this person will be responsible for and facilitates day-to-day clinical operations within the Care Center, including facility opening and closing, managing patient, staff and provider interactions and overall operations
Oversee the operational efficiency and quality of care center services, including direct supervision of medical assistants and patient experience coordinators and other staff as determined by the Director of Operations
Manages and oversees human resources functions, such as hiring, onboarding, and training, and ongoing performance management to build and develop a high-performing team committed to service excellence
Collaborate closely with the Care Center team to ensure the Care Center's performance in effective value-based care and are aligned with Key Performance Indicators (KPIs)
In cooperation with Care Center team, ensures staff meetings and huddles meet Prosano's 'Healthy Huddle' experience standards
Oversee systems and processes vital to the Care Center operations, including scheduling, workflow, and supply management systems
Be an ambassador in the local community - building relationships with other healthcare providers, social/community organizations, and marketing partners
Other duties as assigned
Working hours may include extended hours
This position requires 100% on-site work at the care center location and may also involve movement between clinics as needed

Fulltime

Senior Manager, Clinical Collaboration

The Senior Manager, Clinical Collaboration plays a critical role in strengthenin...

Location

United States

Salary:

140250.00 - 165000.00 USD / Year

Thyme Care

Expiration Date

Until further notice

Requirements

5+ years of experience in healthcare, working with providers, clinical operations, or value-based care models
Experience partnering with provider organizations (oncology, specialty care, or private practice preferred)
Proven ability to lead cross-functional initiatives and drive operational programs from design to execution
Strong understanding of provider workflows and clinical practice operations
Experience influencing internal and external stakeholders without direct authority
Data-driven approach to measuring performance and improving outcomes
Comfortable operating in fast-paced, ambiguous environments

Job Responsibility

Develop, implement, and continuously improve workflows and collaboration models between Thyme Care’s Care Team and oncology practice care teams
Tailor collaboration approaches based on practice preferences, size, and level of desired engagement
Beta test and rollout new products and features that support clinical collaboration
Partner closely with Care Delivery to design and refine operational workflows
Work with Product to identify, define, and support development of tools that enhance communication and coordination with practices
Collaborate with Data Science and Analytics to track interactions, define KPIs, and monitor success metrics
Work alongside Commercial Directors to gather practice feedback, support solution design, and help position collaboration strategies with practices
Serve as a key clinical collaboration partner for oncology practices, engaging directly with practice clinical leadership
Drive regular touchpoints, feedback loops, and problem-solving conversations in partnership with Commercial Directors
Identify opportunities to deepen collaboration, improve satisfaction, and proactively address challenges

Fulltime

Select Country

Director, Value-Based Care

Job Description

Job Responsibility

Requirements

Nice to have

What we offer

Looking for more opportunities?