Strategic Director - Value-Based Care Networks & Ops

SCAN Group; Long Beach (CA); Vor Ort; USD 148.000 - 214.000; Vollzeit

Benefits dieser Stelle

Annual bonus

Wellness program

PTO

Paid holidays

401(k) match

Tuition reimbursement

Zusammenfassung

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.

Qualifikationen

• 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

Aufgaben

• 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)

Kenntnisse

Value-based care

Healthcare operations

Provider networks

Leadership

Strategic thinking

Ausbildung

Bachelor's degree

Jobbeschreibung

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.