Director, Value Based Care Network & Operations Strategy

SCAN Group; Long Beach (CA); On-site; USD 148,000 - 214,000; Full time

Benefits offered by this job

Annual bonus

Wellness program

PTO

Paid holidays

401(k) match

Tuition reimbursement

Job summary

SCAN Group seeks a Director of Value-Based Care Network & Operations Strategy in California to design and implement strategies that improve Total Cost of Care. You will partner with Clinical Programs to drive affordability and network optimization across the organization.

You will lead cost-management programs, oversee network design, contracting, and performance reporting, and collaborate with multiple teams to deliver measurable financial impact.

Qualifications

• 8+ years of experience in value-based care, healthcare operations, provider networks, managed care, or healthcare strategy.
• 5 years of leadership experience
• Bachelor's Degree or equivalent experience in Healthcare Administration, Business, Finance, or related field.
• Strong knowledge of provider contracting, claims operations, payment methodologies, and healthcare economics.
• Medicare Advantage and value-based care experience preferred.
• Demonstrated success leading complex cross-functional initiatives

Responsibilities

• Identify and execute TCoC improvement opportunities in collaboration with Clinical Programs leadership.
• Lead non-clinical cost management programs including Out-of-Area (OOA), CAR-T, transplant, and other high-cost care initiatives.
• Partner with provider relations and member engagement teams to ensure effective provider and member engagement and positive experience.
• Monitor program performance and drive measurable financial impact.
• Lead network design, network sculpting, and specialty contracting initiatives.
• Partner with Network Management to optimize provider and facility networks.
• Identify opportunities to improve referral patterns, steerage, and cost efficiency.
• Collaborate with Payment Integrity, Claims, and Operations to resolve issues impacting medical costs.
• Address gaps such as payments not aligned with contract terms or inaccurate capitation payments.
• Establish accountability and tracking for issue resolution.
• Collaborate with Clinical Programs, Finance, Analytics, Network Management, Member Experience, and Operations teams.
• Lead strategic initiatives from opportunity identification through implementation.
• Develop executive reporting and recommendations on TCoC performance.
• Supervises/Manages Others (i.e. hires, performance reviews, corrective action)

Skills

Value-based care

Healthcare operations

Provider networks

Leadership

Strategic thinking

Education

Bachelor's degree

Job description

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

If you are interested in becoming part of an organization that is innovating senior healthcare visitwww.thescangroup.org,www.scanhealthplan.com, or follow us onLinkedIn;Facebook; andTwitter.

The Job

The Director, Value-Based Care Network & Operations Strategy is responsible for developing and implementing network and operational strategies that improve Total Cost of Care (TCoC). As the dyad partner to the Senior Director, Clinical Programs, this role drives non-clinical affordability initiatives, network optimization, and operational performance improvements that support value-based care goals.

You Will

• Partner with Clinical Programs leadership to identify and execute TCoC improvement opportunities.
• Lead non-clinical cost management programs, including Out-of-Area (OOA), CAR-T, transplant, and other high-cost care initiatives.
• Partner with partner relations and member engagement teams to ensure effective provider and member engagement, and positive experience.
• Monitor program performance and drive measurable financial impact.
• Lead network design, network sculpting, and specialty contracting initiatives.
• Partner with Network Management to optimize provider and facility networks.
• Identify opportunities to improve referral patterns, steerage, and cost efficiency.
• Partner with Payment Integrity, Claims, and Operations teams to resolve operational issues impacting medical costs.
• Address gaps such as: or Payments not aligned with contract terms o Authorization decisions not reflected in claims processing or Incorrect capitation and risk payment administration.
• Establish accountability and tracking for issue resolution.
• Collaborate with Clinical Programs, Finance, Analytics, Network Management, Member Experience, and Operations teams.
• Lead strategic initiatives from opportunity identification through implementation.
• Develop executive reporting and recommendations on TCoC performance.
• Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Supervisory Responsibilities Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)

Actively support the achievement of SCAN's Vision and Goals. Other duties as assigned.

Your Qualifications

• 8+ years of experience in value-based care, healthcare operations, provider networks, managed care, or healthcare strategy.
• 5 years of leadership experience
• Bachelor's Degree or equivalent experience in in Healthcare Administration, Business, Finance, or
• related field.
• Strong knowledge of provider contracting, claims operations, payment methodologies, and healthcare
• economics.
• Medicare Advantage and value-based care experience preferred.
• Demonstrated success leading complex cross-functional initiatives

Competencies

• Business Insight - In-Depth understanding of the business
• Problem Solving - Addresses complex, systemic issues and makes decisions with long-term departmental impact
• Strategic Mindset - Sets departmental direction, integrates cross-functional priorities, and creates strategies that support organizational advantage
• Communication - Communicates departmental strategy, influences senior stakeholders, and builds commitment across functions

Skills/Abilities

• Ability to develop and execute value-based care, network optimization, and Total Cost of Care strategies.
• Strong knowledge of provider contracting, claims operations, payment methodologies, and
• undefined
• Ability to analyze complex operational and financial data, identify cost drivers, and translate findings into actionable recommendations.
• Demonstrated ability to lead complex cross-functional initiatives, influence stakeholders, and drive accountability for measurable outcomes.

What's in it for you?

• Base Pay Range: $147,900 - $214,030 Salary + Incentive Plan
• Work Mode: Preference for California, open to candidates outside CA with willingness to travel 25%
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affitative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

#LI-NL1 #LI-Hybrid

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)