Director of Value Based Care

HopeHealth Inc• Florence, SC, US, SC

About The Position

The Director of Value-Based Care is responsible for the strategic development, operational management, and financial performance of value-based care (VBC) initiatives across the organization. This role oversees payer incentive programs, shared savings arrangements, population health initiatives, and quality performance strategies related to Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), Medicare Advantage plans, UDS Clinical Quality Measures, and other payer contracts. The Director will lead organizational efforts focused on risk adjustment, quality improvement, care coordination, utilization management, and shared savings optimization while ensuring compliance with payer and regulatory requirements. This position also provides leadership for Value-Based Care Coordinators and collaborates closely with clinical, operational, finance, coding, quality, and analytics teams to improve patient outcomes and maximize organizational performance.

Requirements

Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, Public Health, or related field required.
Minimum of 5 years of experience in value-based care, population health, managed care, healthcare operations, quality improvement, or related healthcare leadership role.
Experience with payer incentive programs, shared savings arrangements, risk adjustment, and quality initiatives required.
Strong understanding of value-based reimbursement models, risk adjustment/HCC coding, UDS Clinical Quality Measures, Medicare Advantage and ACO performance measures.
Strong analytical and problem-solving skills with the ability to interpret healthcare data and performance metrics.
Advanced proficiency in Microsoft Excel and experience working with healthcare reporting and analytics tools.

Nice To Haves

Master’s degree preferred.
Experience with Medicare Advantage, ACOs, MCOs, and FQHC quality reporting preferred.
Leadership or supervisory experience preferred.

Responsibilities

Lead the development, implementation, and optimization of value-based care initiatives and population health strategies.
Manage payer incentives and shared savings programs including MCOs, ACOs, Medicare Advantage, and other payer contracts.
Monitor organizational performance related to quality and shared savings benchmarks.
Identify opportunities to improve patient outcomes, reduce avoidable overutilization, and maximize payer incentives and shared savings.
Collaborate with payer partners and internal leadership regarding contract performance and reporting requirements.
Lead organizational quality improvement initiatives related to preventive care, chronic disease management, care gap closure, and population health outcomes.
Oversee performance related to UDS Clinical Quality Measures and other payer quality programs.
Monitor quality dashboards, reports, and trends to identify opportunities for operational and clinical improvement.
Support provider engagement and accountability related to quality and performance initiatives.
Oversee risk adjustment, risk stratification, and coding accuracy initiatives to support compliant documentation and payer reporting requirements.
Lead provider attestation efforts and collaborate with EMR and clinical teams to improve documentation integrity and HCC capture.
Monitor trends and opportunities related to coding accuracy and risk adjustment performance.
Manage and oversee Value-Based Care Coordinators and related staff.
Lead initiatives focused on Hospital Follow-Up (HFU), Annual Wellness Visits (AWV), Transitional Care Management, Care coordination and patient outreach.
Serve as a strategic leader and subject matter expert for value-based care initiatives across the organization.
Collaborate with providers, operations, finance, quality, coding, and executive leadership teams to support organizational goals.
Provide education and guidance related to value-based care, quality performance, and payer expectations.