Value Based Director

Triple-S; Guaynabo (PR); On-site; USD 130,000 - 170,000; Full time

Job summary

Triple-S is seeking a strategic leader to design, implement, and scale value-based transformation across specialty practices. The Director partners with providers, translating performance data and contract objectives into actionable initiatives that improve quality, cost of care, patient outcomes, and financial performance.

Lead interventions addressing clinical workflows, access, care coordination, and revenue cycle while collaborating with Medical, Analytics, Finance, and Pharmacy to maximize

Qualifications

• Master’s degree preferred in healthcare-related field.
• Bachelor’s degree in healthcare-related or analytical field.
• Experience designing and scaling value-based transformation strategies.
• Ability to translate performance data into actionable provider initiatives.

Responsibilities

• Design and implement value-based transformation strategies across specialties.
• Establish operating model, standards, and performance framework aligned with objectives.
• Build trusted advisor relationships with physicians and leadership.
• Lead interventions across clinical workflows, care coordination, and documentation.
• Measure provider performance using HEDIS/STAR/CMS metrics and cost targets.
• Collaborate with Medical, Analytics, Finance, Pharmacy, and providers on opportunities.

Skills

Strategic leadership

Provider partnership

Data-driven decision making

Change management

Education

Master's Degree in Public Health or Health Services Administration

Bachelor's Degree in Public Health or Health Services Administration

Job description

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.

When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Job Summary

Strategic leader responsible for designing, implementing, and scaling the value-based transformation strategy across Specialty Practices. The Director serves as a strategic partner to providers, translating performance data and value-based contract objectives into actionable practice transformation initiatives that improve quality, total cost of care, patient outcomes, provider experience, and financial performance.

Essential Functions

• Establish the operating model, methodology, standards, and performance framework in alignment with organizational priorities and value-based contract objectives.
• Establish a trusted-advisor relationship with physicians and practice leadership creating a provider-centric transformation experience based on transparency, collaboration, and shared accountability.
• Lead interventions addressing clinical workflows, access and capacity, care coordination, referral management, patient engagement, documentation and coding, risk adjustment, revenue cycle, HER optimization and office staff capabilities.
• Develop and oversee provider performance management using: HEDIS, STAR Ratings, CMS measures, Risk Adjustment / RAF, Total Cost of Care, PMPM, Utilization, Readmissions, ED utilization, Medication adherence, Patient experience & Provider experience.
• Establish provider segmentation and differentiated intervention strategies based on performance and opportunity.
• Partner with Medical Management, Analytics, Finance, Pharmacy, and providers to identify opportunities involving: avoidable admissions, emergency department utilization, readmissions, high-cost members, imaging utilization, procedure variation, site-of-care optimization, referral leakage, centers of excellence, specialty pharmacy & therapy optimization
• Partner with Pharmacy and clinical teams to identify opportunities related to: Specialty drug utilization, Biosimilars, Formulary adherence, Medication adherence, Infusion site optimization, Prior authorization, Appropriate therapy utilization & Cost-effective alternatives.
• Partner with Contracting and Finance to translate contract requirements into provider action plans, monitor incentive performance, support provider understanding of value-based economics, identify opportunities for shared savings, evaluate performance against quality and cost targets, support provider readiness for new value-based arrangements & connect transformation activities to financial outcomes.
• Establish the operating standards for Value-Based Transformation Consultants, including: provider assignment, visit methodology, practice assessment, performance review, intervention planning, resource coordination, escalation, follow-up & documentation
• Create an integrated resource model connecting providers with: Medical Directors, Quality, Population Health, Care Management, Pharmacy, Network Management, Provider Relations, Practice Management, Risk Adjustment, Coding/CDI, Analytics, Finance, IT/Digital & Compliance.

EDUCATION

• Master's Degree in Public Health or Health Services Administration
• Bachelor's Degree in Public Health or Health Services Administration

Experience

Master’s degree, preferred, in a healthcare-related field such as Master of Public Health or Master of Health Administration. Or, bachelor’s degree in a healthcare-related or analytical field such as: Public Health, Health Administration, Nursing, Pharmacy, Health Sciences, Business Administration (with healthcare experience), Economics or Data Analytics (with healthcare exposure).

LICENSES AND CERTIFICATIONS

• None required

COMPETENCIES

• Customer Delight
• Financial & Business Acumen
• One Company Mindset
• Practical Knowledge in Tech
• Data Driven Insights

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.