Director, Cost of Care Performance

Pearl Health

2d•$150,000 - $195,000

About The Position

At Pearl Health, you’ll help redefine how primary care succeeds in value-based care by driving meaningful improvements in total cost of care performance while maintaining high-quality, proactive patient care. As Director, Cost of Care Performance, you’ll own the total cost of care strategy—setting the roadmap, designing and leading programs, and driving execution to deliver measurable cost reduction and performance improvement in risk-based models. You’ll translate data-driven insights into high-impact initiatives, manage critical programs and partnerships, and drive reductions in unnecessary, inappropriate, or potentially fraudulent spend, ensuring Pearl’s total cost of care approach delivers sustainable financial and clinical results at scale. Who We Are Pearl Health is dedicated to empowering primary care providers, health systems, and physician-led networks to succeed in the shift to value-based care. Our platform delivers the technology, financial tools, and expert services that enable practices to provide more proactive, effective care to their Medicare patients, ultimately lowering costs and improving health outcomes. Founded in 2020, we are a team of healthcare and technology innovators backed by premier investors like Andreessen Horowitz, Viking Global Investors, and AlleyCorp. We partner with thousands of providers across 44 states to build a more sustainable future for American healthcare. What You'll Do You’ll lead the operational strategy that powers Pearl’s value-based care success, connecting cross-functional teams, data, and execution to drive measurable impact on patient outcomes and provider performance.

Requirements

Bachelor’s degree required; advanced degree (MHA, MBA, MPH, or related) preferred.
8+ years of experience in healthcare operations, value-based care, or health plan management.
5+ years of leadership experience managing cross-functional teams and high-impact initiatives.
Deep understanding of total cost of care, utilization management, and value-based care models.
Proven success translating analytical insights into operational strategy and measurable results.
Experience with Medicare and/or Medicaid programs, including CMS regulations and CMMI models.
Demonstrated experience managing vendors and external partnerships to drive performance.
Strong communication and stakeholder management skills across clinical, technical, and business teams.

Nice To Haves

Experience in healthcare technology, population health, or value-based enablement organizations.
Background working with fraud, waste, and abuse (FWA) prevention programs or risk mitigation processes.
Familiarity with analytics tools, provider performance dashboards, or data visualization platforms.
Experience developing provider-facing materials, training, or education initiatives.
Clinical training or experience (RN, NP, MD, or equivalent), particularly in contexts supporting value-based care or provider education.

Responsibilities

Drive the roadmap for operational programs and partnerships that reduce unnecessary spend and utilization and improve care delivery across Pearl’s provider network.
Partner with Data Science, Product, and Customer Success to size and prioritize strategic opportunities that impact total cost of care.
Translate insights into scalable operational tactics that improve patient outcomes, decrease wasteful spending, and enhance provider experience.
Lead efforts to identify, investigate, and mitigate fraud, waste, and abuse (FWA) — ensuring our processes uphold integrity and quality across the network.
Develop and manage strategic vendor partnerships that advance Pearl’s total cost of care and utilization management objectives.
Partner with Product and Growth teams to transform provider feedback and market learnings into product enhancements and operational improvements.
Collaborate with Customer Success to design, roll out, and optimize provider incentive and engagement programs.
Champion provider education through clear communication materials, guides, and training sessions that support success in value-based care models.