Clinical Value and Transformation

Jefferson Health Plans • Philadelphia, PA

1d

About The Position

The Quality Program and Value Architect serve as a strategic leader responsible for optimizing Jefferson’s performance across value‑based care programs, quality incentive models, and clinical documentation accuracy. This role ensures the organization captures all eligible revenue from value‑based contracts and payer programs by driving operational excellence, financial modeling, and quality outcome improvement. The Architect partners closely with clinical, operational, finance, population health, and analytics teams to design and execute strategies that improve quality scores, enhance patient outcomes, and maximize financial performance.

Requirements

• Deep expertise in value‑based care models, quality program design, and payer incentive structures.
• Strong financial modeling capability, including forecasting, scenario analysis, and opportunity sizing.
• Knowledge of clinical quality measures, documentation standards, utilization management, and risk adjustment.
• Strong analytical proficiency with tools such as SQL, Tableau, Power BI, and predictive modeling platforms.
• Ability to communicate complex concepts effectively to clinical and operational leaders.
• Excellent stakeholder engagement, cross‑functional collaboration, and change‑management skills.
• Bachelor’s degree in healthcare, Finance, Information Technology, or a related field.
• 10+ years of experience in quality improvement, value‑based care program management, healthcare finance, clinical documentation integrity, or related fields.
• Leadership experience required.

Nice To Haves

• Master’s degree preferred.
• CPHQ, CPC, CCDS, CRCR, or certifications related to quality, coding, or documentation integrity.

Responsibilities

• Lead the evaluation, design, and optimization of quality programs and value‑based care initiatives to ensure Jefferson achieves maximum allowable reimbursement.
• Develop and maintain financial models that forecast program performance, incentive opportunities, and risk exposure across value‑based contracts.
• Identify gaps in quality performance, documentation accuracy, and utilization patterns; translate findings into actionable interventions.
• Partner with Clinical Efficiency teams to optimize clinical documentation workflows ensuring accurate capture of patient acuity, case mix index, and DRG assignment.
• Collaborate with analytics, revenue cycle, population health, and IT stakeholders to build dashboards, tools, and governance structures that support sustained improvement.
• Monitor regulatory updates, contract changes, and payer program methodologies to ensure alignment of enterprise strategies.
• Drive initiatives that reduce unwarranted variation, improve patient outcomes, and strengthen financial returns from quality and value‑based programs.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level