Director, Provider Network & VBP (Remote)

Presbyterian; United States; Hybrid; USD 150,000 - 230,000; Full time

Benefits offered by this job

Full medical, dental and vision

Flexible FSAs

Paid time off

Retirement plans with employer match

Continuing education

Life insurance

Short/long-term disability

Wellness programs

Job summary

Presbyterian Healthcare Services seeks a Director of Provider Network Servicing and Value-Based Payments to lead provider engagement, issue resolution, and education across the value-based payment programs. You will partner with Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care and provider relationships.

The role drives transformation toward value-based care, including design, implementation, and performance management of VBP arrangements, with

Qualifications

• Bachelor’s degree or 6 years of additional experience can be substituted in lieu of degree.
• A minimum of 10 years experience in provider relations, provider contracting, claims processing, correct coding, and customer service in a managed care organization including 5 years of progressive leadership experience.
• Strong understanding of reimbursement methodologies (FFS, capitation, shared savings, risk-based models)
• Must possess strong communication skills and be comfortable with public speaking.
• Excellent financial and analytics as well as business acumen and familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex multi-institutional and multi-market environment, joint ventures, and evolving population health and payment models.
• Ability to inspire, influence and lead change in difficult and complex environments.
• Knowledge of current national health care policies and trends, as well as leadership, management, and quality improvement concepts.

Responsibilities

• Lead all aspects of provider servicing operations, including issue resolution, provider education, and ongoing relationship management.
• Serve as the escalation point for complex provider issues, ensuring timely resolution and root-cause remediation.
• Establish standardized servicing models, workflows, and performance expectations across servicing teams.
• Collaborate on provider communication strategies, including outreach, training, and engagement initiatives.
• Lead cross-functional efforts to resolve systemic provider issues involving claims, configuration, and payment accuracy.
• Provide strategic leadership for value-based payment programs, including shared savings, capitation, pay-for-performance, and alternative payment models.
• Oversee design, implementation, and ongoing optimization of VBP arrangements across key provider segments (e.g., primary care, large systems, specialists).
• Partner with Medical Economics to develop financial models, performance benchmarks, and incentive methodologies.
• Ensure alignment between contracting strategies and value-based program objectives.
• Drive provider adoption and maturation along the value-based continuum through education, analytics, and performance reporting.
• Establish performance measurement framework for provider quality, utilization, and total cost of care.
• Oversee development of provider-facing dashboards and internal reporting to monitor VBP and network performance.
• Leverage data analytics to inform provider engagement strategies and financial optimization opportunities.
• Oversee implementation and monitoring of payment models, ensuring accurate configuration and performance tracking.
• Evaluate financial performance of contracts and VBP programs, including impact on Medical Cost Ratio (MCR) and trend.
• Support negotiation strategy by providing insights on provider performance and operational risks.
• Ensure all provider servicing and VBP activities comply with federal, state, and accreditation requirements (e.g., CMS, Medicaid, NCQA).
• Support regulatory reporting and audits related to provider network operations and value-based arrangements.
• Maintain policies and procedures governing provider servicing and VBP operations.
• Build and maintain strategic relationships with key provider organizations and executive stakeholders.
• Lead Joint Operating Committees (JOCs) and provider governance forums.
• Serve as a senior liaison between the health plan and provider community.
• Drive continuous improvement in provider servicing workflows, tools, and technology platforms.
• Partner with IT and analytics teams to enhance provider data, reporting, and automation capabilities.
• Lead transformation initiatives linking provider servicing with population health and clinical operations.
• Lead and develop high-performing teams across provider servicing and VBP functions.
• Establish clear goals, KPIs, and accountability structures aligned with organizations priorities.
• Foster a culture of collaboration, innovation, and continuous improvement.

Skills

Provider relations

Strategic leadership

Data analytics

Cross-functional collaboration

Public speaking

Financial modeling

Change management

Education

Bachelor’s degree or equivalent experience

Tools

Excel/BI tools

Job description

Presbyterian Healthcare Services seeks a Director of Provider Network Servicing and Value-Based Payments to lead provider engagement, issue resolution, and education across the value-based payment programs. You will partner with Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care and provider relationships.

The role drives transformation toward value-based care, including design, implementation, and performance management of VBP arrangements, with