Value Based Care Director - Select Health
About The Position
The Proactive Care Director is responsible for the development, execution, and optimization of the organization’s value-based care (VBC) strategy across Medicare Advantage and other risk-based lines of business. This role provides enterprise leadership for provider risk arrangements, payment model design, performance management, and the integration of clinical, financial, and operational strategies to improve quality, experience, and total cost of care. The Director partners closely with executive leadership, provider organizations, and internal clinical and financial teams to advance value-based transformation while maintaining strong provider relationships and financial sustainability. The Proactive Care Director leads the organization’s approach to value-based contracting and performance strategy. This role is accountable for defining risk models, setting performance expectations, aligning incentives, and ensuring that value-based arrangements drive measurable improvements in quality, member experience, and cost outcomes. The position serves as a strategic bridge between providers, clinical operations, finance, and analytics, translating enterprise goals into actionable provider strategies and sustainable payment models. Success in this role requires deep expertise in value-based care models, strong financial and analytical skills, and the ability to influence provider behavior at scale.
Requirements
- Bachelor’s degree in Healthcare Administration, Business, Finance, Public Health, or a related field.
- Ten (10) or more years of progressive experience in value-based care, provider strategy, healthcare finance, or managed care.
- Seven (7) or more years of experience designing or managing provider risk arrangements or value-based programs.
- Demonstrated success designing and scaling advanced risk arrangements, including partial and full capitation, global budgets, or population-based payment models.
- Experience aligning quality, utilization management, care management, and population health programs to value-based performance goals.
- Demonstrated experience working directly with providers, health systems, or physician organizations.
- Proven ability to lead cross-functional initiatives across clinical, financial, and operational teams.
- Strategic planning
- Financial management
- Contracting
- Risk contracts
- Financial modeling
- Analytical skills
- Written / verbal communication
- Presentation skills
- Provider engagement
- Dashboard development
Nice To Haves
- Experience leading enterprise value-based care strategy within a Medicare Advantage organization, provider-sponsored health plan, or integrated delivery system.
- Familiarity with risk adjustment, Star Ratings, quality bonus payments, and CMS policy as they relate to value-based strategy in Medicare Advantage.
Responsibilities
- Develop and execute the enterprise value-based care strategy across Medicare Advantage and other applicable lines of business.
- Design and oversee provider risk arrangements, including shared savings, downside risk, capitation, and global budget models.
- Partner with Finance and Actuarial teams to ensure financial sustainability, risk adjustment accuracy, and margin performance.
- Establish provider performance frameworks that align quality, cost, utilization, and experience metrics.
- Lead the development of provider incentives, scorecards, and performance reporting.
- Partner with Clinical Operations to align care management, utilization management, and population health strategies to VBC goals.
- Collaborate with Analytics teams to define performance measurement, attribution, benchmarking, and forecasting.
- Serve as a senior leader in provider engagement, including contract negotiations, performance reviews, and strategic planning.
- Oversee governance structures for value-based programs, including executive committees and provider councils.
- Monitor market trends, CMS policy changes, and emerging value-based models; translate into strategic recommendations.
- Drive adoption of value-based workflows and accountability across internal teams and provider organizations.
- Support enterprise initiatives that align value-based strategy with quality performance, consumer experience, and Star Ratings.
- Communicate progress, risks, and opportunities to executive leadership and Boards.
Benefits
- Comprehensive benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
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What This Job Offers
Job Type
Full-time
Career Level
Director
