Director of Value Care

Overview

JOB SUMMARY

The Director of Value-Based Care (VBC) Programs is responsible for setting and leading the planning, development, implementation, and optimization of Comm Unity Care ’s value-based care and population health initiatives across all service lines. They will work closely with the Chief Pop Health and Integration officer to set the strategy and direction across multiple programs or departments with organization-wide impact including long-term planning at the enterprise level.

This role ensures alignment of care management, quality, and operational programs with payer contracts, HRSA/UDS requirements, and organizational goals to improve outcomes, enhance patient experience, and support financial sustainability. This position serves as a bridge between clinical operations, data analytics and payer relations to drive improved outcomes and reduce patient’s overall costs to ensure financial sustainability of the VBC contract outcomes.

The director leads other managers or cross-functional teams to reach outcome goals and strategic initiatives.

The Director will lead Care Management, Community Health Social Services, and other members of the Collaborative Care Team including clinical pharmacists, dietitians and behavioral health, to support whole person care and implement value-based care best practices including setting overall team direction as it relates to VBC strategy. This position will work closely with our Care Model and Performance Improvement teams to continue innovating best models that support organizational goals.

• Lead and oversee value-based care program operations, ensuring integration across clinical, social, and community health teams.
• Monitor and analyze performance metrics to improve quality, reduce total cost of care, and enhance patient outcomes under VBC contracts.
• Collaborate with payer partners, data analytics, and internal stakeholders to align operational strategies with financial and clinical performance goals.
• Develop and maintain workflows, training, and tools that promote care coordination, team-based care, and population health management excellence.
• Ensure compliance with HRSA, UDS, Joint Commission, and PCMH standards while supporting continuous improvement and innovation in care delivery.
• Lead daily operations of VBC initiatives within the VBC payer program including Chronic Care Management (CCM), Transitions of Care (TOC), and population health programs in conjunction with the Care Management Team, Community Health Worker Team and front-line Collaborative Care Teams.
• Serve as a subject matter expert to translate payer contract requirements and population health goals into actionable workflows and ensure alignment with collaborative care/clinical teams.
• Support care model changes including pilots to scale-up of care coordination/navigator programs for high-risk patients.
• Track, analyze, and report on VBC metrics (HEDIS, UDS, payer-specific measures, MLR, utilization trends).
• Support the development of dashboards in collaboration with Business Intelligence VBC analyst to monitor progress and inform decision-making.
• Analyze payer-provided data along with EMR data to inform strategy on closing care gaps and design targeted outreach opportunities with care teams to improve key metrics and patient outcomes including HEDIS, STAR and risk adjustment scores.
• Accountability for payer strategy, contract enhancements/design and manage key external partnerships.
• Work with CPHIO on shared savings and risk strategy at the system level.
• Monitor financial performance of VBC contracts, including shared savings, risk arrangements, and quality incentive payments adjusting interventions based on real-time data including payer expectations.
• Monitor ROI of care management programs (e.g., CCM reimbursement, ED diversion, readmission reduction); accountable for major performance and financial outcomes.
• Support leadership in payer negotiations by providing performance insights and opportunity analyses.
• Meet with payer account managers to review performance and establish new initiatives based on data insights.
• Standardize workflows for preventive and chronic care management,…