Executive Director-Clinical Program Portfolio Strategy and Financial Performance

Presbyterian Healthcare Services

6d•Remote

About The Position

The Executive Director, Clinical Program Portfolio Strategy and Financial Performance is responsible for leading the financial and strategic oversight of the health plan’s clinical program portfolio. This role ensures that medical cost performance, utilization patterns, and market trends are rigorously analyzed and translated into actionable insights that support member affordability, value based care performance, and enterprise financial objectives. The Executive Director partners closely with Medical Economics, Actuarial, Finance, Product, and Clinical leadership to drive disciplined portfolio management, forecast medical cost trends, and assess financial sustainability across current and emerging clinical programs.

Requirements

10+ years of progressive leadership experience in healthcare, health plans, or integrated delivery systems, health policy, with demonstrated accountability for financial performance, strategic planning, and clinical program oversight
Deep expertise in health policy, population health, value-based care, and provider performance management, with the ability to evaluate clinical program effectiveness through a financial lens
Strong understanding of Medicare, Medicaid, and Commercial lines of business, including how clinical quality, utilization patterns, and market dynamics translate into medical cost performance and financial outcomes
Demonstrated ability to translate clinical, quality, and market performance data into financial value and impact, quantifying implications for total cost of care, trend management, and enterprise financial performance
Proven success in linking clinical outcomes, utilization, and population health performance to financial results, including cost savings, revenue optimization, and risk mitigation
Advanced capability to synthesize complex clinical, operational, and market data into actionable financial insights, informing pricing, forecasting, and strategic investment decisions
Experience in medical cost trend analysis, financial forecasting, and portfolio performance management, including variance analysis, scenario modeling, and long-range planning
Demonstrated success leading cross-functional initiatives in partnership with Actuarial, Finance, Medical Economics, Clinical, Product, and Network teams to drive aligned financial and clinical outcomes

Nice To Haves

Advanced degree (MBA, MPH, MHA, or related field)
Experience in integrated delivery systems or provider-sponsored health plans, with a strong understanding of payer-provider alignment and clinical-financial integration
Familiarity with risk-based contracting and capitation models, including full-risk, shared savings, and alternative payment models
Experience supporting enterprise financial strategy, including pricing, product design, and multi-year medical cost management
Demonstrated ability to lead analytic functions or teams, ensuring rigor, standardization, and translation of insights into business value

Responsibilities

Provide executive leadership for the financial performance management of the health plan’s clinical program portfolio, with a focus on total cost of care, utilization management, and value based reimbursement models.
Establish and maintain standardized frameworks for evaluating portfolio performance, including financial impact, trend influence, and alignment to health plan strategy.
Support portfolio prioritization and investment decisions through performance measurement, financial modeling, and market informed analysis.
Lead the analysis of financial, clinical, and utilization data to assess historical performance and project future medical cost trends at the portfolio, product, and population level.
Oversee advanced financial forecasting and scenario modeling to inform budgeting, pricing, and strategic planning processes.
Collaborate with Actuarial and Finance teams to ensure clinical program assumptions are incorporated into medical trend projections and enterprise financial plans.
Prepare and review detailed variance analyses comparing actual performance to expected cost, utilization, and savings targets.
Identify root causes of unfavorable performance, assess financial risk, and develop corrective action recommendations in partnership with clinical and operational leaders.
Provide senior leadership with clear, timely insights regarding emerging risks, performance gaps, and opportunities for improvement.
Monitor external market conditions, industry benchmarks, and evolving care models that influence medical cost performance and clinical program effectiveness.
Assess competitiveness and value of clinical programs relative to peer health plans and regional markets.
Integrate market intelligence into portfolio evaluations, financial forecasts, and strategic recommendations.
Oversee the preparation of executive level financial and performance reporting to support ongoing management reviews and governance forums.
Ensure reporting effectively communicates portfolio level insights related to medical cost containment, utilization trends, and program value.
Partner with Product and Clinical leaders to align insights with benefit design, program enhancements, and member focused strategies.
Serve as a strategic advisor to health plan leadership on clinical program economics, medical cost management, and portfolio optimization.
Support long range financial planning and multi year medical cost strategies in alignment with enterprise objectives.
Collaborate across Clinical, Medical Economics, Actuarial, Pharmacy, Provider Networks, and Operations to ensure coordinated execution of portfolio strategies.
Build strong, collaborative relationships across actuarial, finance, clinical, and product teams to drive shared accountability for outcomes.
Lead analytic resources ensuring high standards for analytical rigor, consistency, and interpretability.
Promote a culture of evidence based decision making and proactive financial stewardship within the health plan.