Director-Provider Services-Health Plan (remote/hybrid)

PHP Administrative; Albuquerque (NM); Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Competitive salaries

Full medical, dental, and vision

Paid time off

Retirement plans

Continuing education opportunities

Job summary

Presbyterian Healthcare Services is seeking a Director of Provider Network Servicing and Value-Based Payments to lead operations and strategy for provider engagement. This senior role focuses on improving provider relationships and driving excellence in value-based payment programs.

The ideal candidate will have significant experience in managed care, strong leadership skills, and the ability to inspire change.

Qualifications

• Minimum 10 years experience in provider relations and contracting.
• Strong understanding of reimbursement methodologies.
• Experience in managed care organization leadership.

Responsibilities

• Lead provider servicing operations and issue resolution.
• Establish servicing models and workflows across teams.
• Drive value-based payment program strategies.

Skills

Provider relations

Claims processing

Public speaking

Data analytics

Financial acumen

Leadership

Education

Bachelor’s degree or equivalent experience

Job description

Location Address:9521 San Mateo NE Albuquerque, NM 87113-2237Summary:The Director of Provider Network Servicing and Value-Based Payments is a senior leadership role responsible for the strategic oversight, performance, and integration of provider servicing operations and value-based payment (VBP) programs across all lines of business.This role ensures a high-performance provider network by driving operational excellence in provider engagement, issue resolution, and education, while advancing the transition to value-based care through effective program design, implementation, and performance management.The position partners closely with Provider Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care, improve quality outcomes, and strengthen provider relationships.Work Arrangement• Remote: Open to applicants in the United States, excluding IL, ND, NY, WA, and WY.• Hybrid (Strongly Preferred): For individuals within 60 miles of Albuquerque, in-officepresence is required Tuesday through Thursday.Job Description: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.Additional Job Description:• 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.BenefitsBenefits are effective day-one (for .45 FTE and above) and include:Competitive salariesFull medical, dental and vision insuranceFlexible spending accounts (FSAs)Free wellness programsPaid time off (PTO)Retirement plans, including matching employer contributions Continuing education and career development opportunitiesLife insurance and short/long term disability programsAbout UsPresbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.About New MexicoNew Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.