Senior Director, Health Plan and Self-Funded Employer Relationships

Guidehealth•Atlanta, GA

2d•Remote

About The Position

The Sr. Director, Health Plan Relationships is the executive owner of assigned self-insured health plan client relationships and serves as the primary liaison between client leadership and internal operations. This role is accountable for seamless client transition from Sales through implementation and into ongoing performance management and servicing. The Sr. Director owns the day-to-day executive relationship, performance delivery oversight, and strategic value realization across care management, analytics and analytic platform, utilization management, claims processing, benefits administration, and HEDIS quality performance. The Sr. Director ensures that each client achieves measurable improvement in total cost of care, utilization efficiency, quality outcomes, and member experience — positioning the organization as the market-leading high-value, low-cost partner in value-based health plan services. This position ensures seamless transition from commercial promise to operational performance. By owning the full client lifecycle — from contract signature through implementation and into measurable value realization — the Sr. Director directly safeguards retention, revenue stability, and market differentiation.

Requirements

4+ years of experience in healthcare client service and strategy, program implementation, and/or support for value-based care services and technologies.
Demonstrated experience leading client implementations and cross-functional onboarding processes.
Healthcare and value-based care dynamics
Utilization management processes
Claims processing and benefit administration
Population health analytics
HEDIS quality measurement
Demonstrated experience managing executive-level client relationships.
Strong financial acumen with ability to analyze cost-of-care drivers and ROI.
Exceptional communication and executive presentation skills.
Ability to travel up to 50% to client locations.

Nice To Haves

Clinical or advanced business degree (MBA, MHA, MPH, RN)
Experience working with employer-sponsored health plans or TPAs.
Background in value-based care models or alternative payment arrangements.
Familiarity with population health analytics platforms and reporting tools.

Responsibilities

Serving as the executive owner of new client transitions from Sales to contract execution.
Leading formal handoff process from Sales to Operations, ensuring scope clarity, contractual alignment, performance guarantees, and implementation readiness.
Working with Operations to develop a summary implementation plan that can be used for client alignment and tracking
Establishing implementation governance structure, milestone tracking, and executive reporting cadence.
Ensuring on-time, on-budget, and contractually compliant go-live.
Partnering with implementation, operational, and consultative teams to drive successful onboarding, including, where applicable, based on contract scope: Data integration and eligibility feeds, Claims platform setup and configuration, Benefit plan build validation, Utilization management program alignment, Care management workflows and member outreach readiness, Analytics platform deployment and reporting configuration
Transitioning the client from the implementation phase to steady-state servicing with clear performance baseline metrics and first-year value roadmap.
Maintaining continuous lifecycle ownership through renewal and expansion.
Serving as the single accountable executive point of contact for assigned self-insured employer health plans.
Building trusted, C-suite relationships (HR, Finance, Benefits, Population Health leadership).
Acting as the conduit for surfacing blockers to senior client leaders (in sync with operations) in a clear, actionable, and trust-based manner
Leading recurring executive business reviews (QBRs), performance reviews, and strategic planning sessions.
Providing consultative support to client executive and operational teams to increase customer/company synergies.
Translating complex operational and clinical data into clear executive-level insights and actions.
Ensuring proactive communication of performance trends, risks, and mitigation strategies.
Overseeing Guidehealth accountability for: Total cost of care (TCOC), Utilization management effectiveness (IP vs ASC site-of-care optimization, medical necessity integrity, observation vs inpatient trends, SNF LOS), Care management engagement and impact, Claims accuracy and financial integrity, Benefit plan performance and optimization, HEDIS gap closure and quality outcomes
Partner cross-functionally with operations, clinical leadership, analytics, and claims teams to ensure contractual performance delivery.
Identify operational gaps and drive corrective action plans alongside Operations with clear timelines and accountability.
Analyzing client-specific claims, utilization, quality, and engagement data to identify: Cost containment opportunities, Site-of-care migration opportunities, Avoidable ED/IP utilization reduction strategies, Pharmacy optimization opportunities, Quality improvement and risk capture gaps, Benefit design leverage points
Develop strategic recommendations that align financial performance with improved member outcomes.
Quantify ROI and document realized savings and quality gains.
Identifying opportunities for service expansion within existing accounts (analytics platform adoption, UM enhancements, care management programs, etc.).
Supporting renewal strategy and retention through demonstrable performance and executive alignment.
Contributing to client case studies and market differentiation efforts.
Ensuring care programs and operational workflows are optimized for a seamless member experience.
Monitoring member satisfaction indicators and recommending process improvements.
Advocating for client members internally to ensure frictionless navigation across services.