Lead Director, Provider Performance Value-Based Care Job at CVS Health

Provider Contracting Lead (Director), Americas

This leadership role drives the execution of Cigna Healthcare’s global network s...

Location

United States , Remote

Salary:

156700.00 - 261100.00 USD / Year

The Cigna Group

Expiration Date

Until further notice

Requirements

Bachelor’s degree required
master’s degree in business, healthcare administration, or related field strongly preferred
Minimum 10 years’ experience in international healthcare provider contracting, with deep expertise in negotiation, cost control, and value-based care models in the Americas region
Excellent verbal and written English
proficiency in Spanish is required
Demonstrated success in leading complex contract negotiations and implementing innovative contracting solutions
Proven ability to drive cost management, affordability initiatives, and value-based care strategies at scale
Advanced knowledge of healthcare reimbursement methodologies, contracting principles, legal requirements, and regulatory frameworks
Exceptional communication, facilitation, presentation, and executive leadership skills
ability to influence and motivate across countries and functions

Job Responsibility

Develop, execute, and continuously refine the Americas provider contracting and network strategy, aligning with global objectives and local market dynamics
Lead high-stakes contract negotiations with healthcare providers and TPAs, securing optimal terms that advance organizational goals for access, cost control, affordability, and value-based care
Design and implement innovative contracting models (e.g., risk-sharing, bundled payments, pay-for-performance) to drive value-based outcomes and sustainable cost management
Own and manage strategic relationships with key vendors and TPAs, identifying new partnership opportunities to expand network reach and enhance value for customers and clients
Direct and mentor a team of network leads and analysts, fostering a culture of excellence, accountability, and continuous improvement
Influence and collaborate with senior business partners and stakeholders in a highly matrixed, cross-functional environment
Establish robust governance frameworks for Americas contract compliance, risk mitigation, and regulatory adherence
Continuously evaluate the provider network for gaps, redundancies, and opportunities for expansion or consolidation, leveraging data-driven insights to inform strategic decisions
Drive implementation of strategic initiatives with providers, including automation and provider self-service solutions, to enhance efficiency and engagement
Champion digital transformation to support cost control, affordability, and value-based care

What we offer

annual bonus
long term incentive plan
medical
vision
dental
well-being and behavioral health programs
401(k)
company paid life insurance
tuition reimbursement
a minimum of 18 days of paid time off per year

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

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

Supervisor RN Post Acute Care Population Health

The Post Acute Care Supervisor will support the Team Leader in the overall visio...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Bachelor of Science in Nursing (BSN) preferred
4 years post-acute nursing experience, which includes home health, skilled nursing facility, inpatient rehab facility, and/or LTACH required
2 years in a supervisory role required
5 years supporting value-based care programs, accountable care organizations, or utilization management preferred
Strong leadership, communication, and organizational skills
ability to manage multiple tasks and work under pressure required
RN license in the state of employment or compact is required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Supports leadership with day-to-day operations: including but not limited to selection, training, development, performance management, staffing, and productivity of associates within the Post Acute team for the ACO/CIN
Provide ongoing mentorship to associates to foster professional growth and development
Use performance metrics and expectations to objectively assess staff performance
Monitor post-acute spend for clinics assigned to each nurse and establish goals
Collaborate with manager on strategic plans to enhance team performance and achieve departmental goals
Fosters team engagement and drives performance management by recognizing and rewarding high achievers, while inspiring and motivating individuals to reach their full potential
Understands and supports 'Triple Aim' objectives of an ACO/CIN and promotes these objectives in concert with organizational Core Values when supervising and leading the team
Optimize resource allocation to maximize efficiency and ensure team expectations are met
Maintains appropriate staffing ratios and team assignments based on volumes

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

Manager / Director Business Analytics

We are looking for Job Title: Manager / Director Business Analytics. We are seek...

Location

United States

Salary:

Not provided

SpectraMedix

Expiration Date

Until further notice

Requirements

12+ years of experience in healthcare analytics, management consulting, actuarial consulting, payer strategy, or value-based care environments
Deep knowledge of healthcare economics, payer operations, and value-based care performance drivers
Strong understanding of HEDIS, NCQA, Stars, risk adjustment, utilization management, and provider incentive models
Proven ability to analyze large healthcare datasets including claims, pharmacy, eligibility, provider, and clinical data
Strong financial modeling skills including ROI, PMPM analysis, trend forecasting, and scenario modeling
Experience presenting to executive audiences and influencing senior stakeholders
Demonstrated success leading complex client engagements and delivering measurable outcomes
Experience managing teams, developing talent, and overseeing high-quality work product
Strong technical fluency with SQL, Excel, and BI platforms such as Tableau or Microsoft Power BI
Excellent written and verbal communication skills with strong executive presence

Job Responsibility

Strategic Client Advisory: Serve as a trusted advisor to executive client stakeholders across analytics, network, finance, quality, and value-based care functions
Translate complex performance data into clear strategic recommendations tied to quality improvement, MLR performance, provider engagement, and financial outcomes
Lead executive presentations, steering committees and high-impact client discussions
Identify growth opportunities, operational risks, and emerging market trends affecting client performance
Value-Based Care Leadership: Demonstrated experience navigating the intricacies of VBC contract language (e.g., attribution logic, risk adjustment factors, and benchmark methodology)
Advise clients on value-based care models including pay-for-performance, shared savings, downside risk, capitation, and incentive programs
Interpret HEDIS, NCQA, Stars, risk adjustment, and utilization metrics within the context of provider contracts and health plan economics
Delivery Excellence & Scalable Execution: Establish rigorous standards for data quality, reconciliation, methodology transparency, and audit readiness
Build repeatable reporting frameworks, templates, and scalable processes that improve efficiency and consistency
Identify automation opportunities across recurring reporting, dashboard production, and insight generation

Fulltime

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Lead Director, Provider Performance Value-Based Care

Job Description

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