Director Value Based Care

Job Description

The Director, Value-Based Care is responsible for operationalizing value-based care government and private payor programs and strategy. In this role you will play a pivotal role in the overall success of the organization, ensuring proper implementation, operationalization, and tracking of value-based care programs.

You will ensure program success through collaboration with cross-functional teams, regulatory compliance, and performance monitoring. This role will oversee all aspects of performance-based reimbursement models, payer relationships, provider engagement, and population health strategies to ensure financial sustainability and clinical excellence.

Major Responsibilities / Tasks :

• Serve as an organizational subject matter expert (SME) and tactical lead for ACO REACH and other Center for Medicare and Medicaid Innovations (CMMI) programs; knowledgeable of emerging trends within CMMI models.
• Lead the strategic development and implementation of VBR programs including shared savings, capitation, bundled payments, and risk-based models.
• Will hire and manage Quality Department to ensure the achievement of all quality goals, programs. risk management and compliance oversight. Training, monitoring and evaluating Quality Department Staff.
• Responsible for ensuring that the Company achieves the goals and objectives associated with all Payor Quality Programs including, but not limited to, the Aledade / BCBS-NC ACO.
• Establish a fluid working relationship with Aledade management and staff support.
• Develop an annual quality management plan, quality department budget and identify strategic quality initiatives and opportunities.
• Will develop key analytical quality Key Performance Indicators (KPI’s).
• Will work in conjunction with Lead Quality Physician to help drive quality policies, procedures and business practices to ensure that the Company achieves all Quality Program Initiatives and Shared Savings associated for both the Commercial and Medicare ACO.