Director, Value Based Care Network & Operations Strategy

SCAN Health Plan • Long Beach, CA

7d • Onsite

About The Position

The Director, Value-Based Care Network & Operations Strategy develops and implements network and operational strategies to improve Total Cost of Care (TCoC). As the dyad partner to the Senior Director, Clinical Programs, this role leads non-clinical affordability initiatives, network optimization, and operational performance improvements that support value-based care goals. The position works across clinical programs, finance, analytics, network management, member experience, and operations to identify opportunities, implement strategic initiatives, track results, and provide executive reporting and recommendations.

This role supervises and manages others, including responsibilities such as hiring, performance reviews, and corrective action. The Director is also expected to support SCAN’s vision and goals and to remain curious about AI and its potential to transform operations and member service. The position is mostly onsite.

Requirements

• At least 8 years of experience in value-based care, healthcare operations, provider networks, managed care, or healthcare strategy.
• At least 5 years of leadership experience.
• Bachelor’s degree or equivalent experience in Healthcare Administration, Business, Finance, or a related field.
• Strong knowledge of provider contracting, claims operations, payment methodologies, and healthcare economics.
• Ability to develop and execute value-based care, network optimization, and Total Cost of Care strategies.
• Ability to analyze complex operational and financial data, identify cost drivers, and translate findings into actionable recommendations.
• Demonstrated ability to lead complex cross-functional initiatives, influence stakeholders, and drive accountability for measurable outcomes.
• Ability to address complex, systemic issues and make decisions with long-term departmental impact.
• Ability to set departmental direction, integrate cross-functional priorities, and develop strategies that support organizational advantage.
• Ability to communicate departmental strategy, influence senior stakeholders, and build commitment across functions.

Nice To Haves

• Medicare Advantage and value-based care experience preferred.
• Curiosity about AI and its potential to transform operations and member service.

Responsibilities

• Partner with Clinical Programs leadership to identify and execute Total Cost of Care improvement opportunities.
• Lead non-clinical cost management programs, including Out-of-Area (OOA), CAR-T, transplant, and other high-cost care initiatives.
• Partner with partner relations and member engagement teams to support effective provider and member engagement and positive experiences.
• Monitor program performance and drive measurable financial impact.
• Lead network design, network sculpting, and specialty contracting initiatives.
• Partner with Network Management to optimize provider and facility networks.
• Identify opportunities to improve referral patterns, steerage, and cost efficiency.
• Partner with Payment Integrity, Claims, and Operations teams to resolve operational issues that affect medical costs.
• Address issues including payments not aligned with contract terms, authorization decisions not reflected in claims processing, and incorrect capitation and risk payment administration.
• Establish accountability and tracking for issue resolution.
• Collaborate with Clinical Programs, Finance, Analytics, Network Management, Member Experience, and Operations teams.
• Lead strategic initiatives from opportunity identification through implementation.
• Develop executive reporting and recommendations on Total Cost of Care performance.
• Supervise and manage others, including hiring, performance reviews, and corrective action.
• Actively support the achievement of SCAN’s vision and goals.
• Perform other duties as assigned.

Benefits

• Annual employee bonus program and incentive plan.
• Robust wellness program.
• Generous paid time off (PTO).
• 11 paid holidays per year, one floating holiday, birthday off, and two volunteer days.
• 401(k) retirement savings plan with employer match.
• Employee recognition program.
• Tuition reimbursement.

What This Job Offers

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