Director, Value Based Care Network & Operations Strategy

SCAN Health Insurance•Long Beach, CA

9d•$147,900 - $214,030•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 advance value-based care goals. The position works across clinical, financial, network, analytics, member experience, and operations functions, leading strategic initiatives from opportunity identification through implementation and reporting on TCoC performance. The role supervises and manages others, including hiring, performance reviews, and corrective action. The director is also expected to support SCAN’s vision and goals and perform other duties as assigned.

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.
Strong business insight and in-depth understanding of the business.
Ability to address complex, systemic issues and make decisions with long-term departmental impact.
Ability to set departmental direction, integrate cross-functional priorities, and create 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.

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 affecting medical costs, including payments misaligned 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 employees, including hiring, performance reviews, and corrective action.
Support achievement of SCAN’s vision and goals and perform other duties as assigned.