Lead Director, Provider Performance, Value-Based Care

This is a fully remote position, open to applicants in North Carolina, +1 more state.

📋 Description

• Create and nurture productive relationships based on value with key network providers.

• Develop and oversee the Keystone Value-based Network.

• Establish strategic partnerships with providers and create innovative value-based solutions aimed at achieving total cost and quality objectives.

• Formulate alternative payment models and identify new initiatives for planning.

• Negotiate high-value/risk contracts with intricate arrangement structures.

• Gain a comprehensive understanding of providers' volume and cost structures.

• Collaborate across functions to identify negotiation levers and critical negotiation points.

• Align negotiation strategies and tactics with goals related to network accessibility, quality, compliance, and financial performance.

• Oversee the entire value-based contracting cycle, which includes planning, document creation, negotiation, and loading of executed agreements.

• Collaborate with Performance, Clinical Transformation, VBS Analytics, and other internal teams to formulate strategic plans and monitor contract performance.

• Assess, create, and implement strategic plans for the network to achieve value-based contracting objectives and manage medical costs.

• Assist other departments in acquiring necessary provider information, including HEDIS, Credentialing, Grievance and Appeals, and SIU information.

• Coordinate provider status information with member services and other internal teams.

• Lead complex projects and initiatives from assessment through implementation across various processes, systems, functions, and products.

• Facilitate and participate in external provider meetings and negotiations as required.

⛳️ Requirements

• A minimum of 10 years of relevant experience.

• Proven negotiating skills with a successful history of negotiating value-based contracts with IPAs, large complex provider systems or groups, hospitals, and substantial physician entities.

• Experience in reviewing medical claims data.

• Familiarity with developing executive summaries and identifying opportunities to reduce medical cost trends.

• Strong analytical and problem-solving capabilities.

• Excellent communication, negotiation, and presentation skills.

• Ability to operate effectively within a matrixed organization, achieve consensus, and share information with diverse stakeholders.

• Preference for familiarity with legal terminology in the context of provider contracting.

• Preference for knowledge of CMS Stars and HEDIS technical specifications, including measurable percentiles related to HEDIS measures.

• Preference for experience with Commercial, Medicare, and Medicaid contracting.

• Ability to utilize systems thinking when managing various provider value-based initiatives is preferred.

• A strong background in financial modeling is preferred.

• A Bachelor’s degree is preferred or a combination of professional experience and education.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.