Job Summary

The Director of Population Health will provide strategic direction, leadership, and oversight of all population health initiatives within a large Integrated Delivery System (IDS). The incumbent will be responsible for the planning, development, and implementation of comprehensive population health, value-based care, and performance improvement programs. This includes oversight of HEDIS measures, care management, risk stratification, and utilization management to enhance care quality, promote cost savings, and improve patient outcomes.

Responsibilities

1. Population Health Strategy & Program Development

Develop and implement a system-wide strategy for population health management aligned with the organization's mission, vision, and values.

Lead the design and execution of innovative care delivery and value-based initiatives to support improved health outcomes and cost efficiency.

Collaborate with senior leadership to set short- and long-term goals and performance metrics for population health, ensuring alignment with organizational strategy.

2. HEDIS Oversight and Quality Reporting

Oversee the development, implementation, and monitoring of HEDIS-related processes to ensure the highest level of quality and compliance with regulatory requirements.

Ensure accurate and timely data collection, reporting, and analysis for HEDIS, CMS Stars, and other quality measures.

Identify performance gaps and drive improvement initiatives to enhance HEDIS performance across the organization.

3. Care Management and Coordination

Provide leadership and direction for care management teams, including nurses, social workers, and care coordinators, to ensure effective care coordination for high-risk, high-cost patient populations.

Implement risk stratification models and evidence-based care pathways to optimize patient outcomes and resource utilization.

Ensure coordinated transitions of care, reduce readmissions, and improve patient engagement through strong interdepartmental collaboration.

4. Utilization Management

Oversee utilization management activities, ensuring adherence to clinical guidelines and best practices to optimize care delivery and reduce unnecessary costs.

Collaborate with providers, payers, and care teams to design and implement strategies to reduce avoidable hospital admissions, readmissions, and Emergency Department (ED) visits.

Drive the utilization review process, establishing benchmarks and key performance indicators to monitor performance and identify improvement opportunities.

5. Data Analytics and Technology Integration

Work closely with IT and Data Analytics teams to leverage population health management software and analytic tools for monitoring, trending, and forecasting clinical and financial outcomes.

Utilize data-driven insights to identify population health trends, develop targeted interventions, and measure program effectiveness.

Champion the use of electronic health records (EHR) to streamline care coordination, clinical documentation, and performance reporting.

6. Collaboration and Stakeholder Engagement

Develop strong partnerships with physicians, clinical leaders, external healthcare organizations, community-based organizations, and payers to foster a culture of collaboration for population health initiatives.

Serve as a subject matter expert for population health and value-based care, providing education, training, and guidance to internal stakeholders.

Represent the organization in community forums, professional associations, and conferences to promote best practices in population health.

7. Regulatory Compliance and Accreditation

Maintain current knowledge of federal, state, and local regulations and accreditation standards related to population health, quality, and value-based care.

Ensure the organization's compliance with regulatory requirements and accreditation standards (e.g., NCQA, CMS) related to population health and quality programs.

Lead audits, accreditation processes, and quality improvement initiatives to meet and exceed compliance obligations.

8. Financial and Operational Management

Develop and manage the budget for population health initiatives, ensuring cost-effectiveness and alignment with strategic priorities.

Monitor financial performance and ROI for population health programs, implementing course corrections as needed.

Identify and secure grants, partnerships, and other funding opportunities to support and expand population health efforts.

9. Leadership and Team Development

Recruit, mentor, and retain high-performing population health and care management teams, fostering a culture of innovation and continuous learning.

Provide leadership, coaching, and professional development opportunities to direct reports and cross-functional team members.

Establish performance expectations and conduct regular performance evaluations, ensuring accountability and alignment with organizational goals.

Qualifications

1. Education and Certification

Master's degree in public health, Health Administration, Nursing, Business Administration, or a related field required.

Clinical background (RN, MD/DO, or similar) preferred but not required.

Certification in Population Health Management, Case Management, or Healthcare Quality (e.g., CPHQ, CCM) is highly desirable.

2.Experience:

Minimum of 7-10 years of progressive leadership experience in population health, care management, or quality improvement within a large integrated delivery system or health plan.

Demonstrated success in implementing and overseeing HEDIS, CMS Star Ratings, or other quality improvement programs.

Proven track record of leveraging data analytics to drive strategic decisions, reduce costs, and improve clinical outcomes.

Experience in leading interdisciplinary teams and managing complex, system-wide initiatives.

3. Knowledge and Skills:

In-depth knowledge of population health principles, healthcare delivery models, and value-based care arrangements (e.g., ACOs, bundled payments, capitation).

Familiarity with healthcare regulations, accrediting body standards (e.g., NCQA), and best practices in quality management and performance improvement.

Exceptional analytical and problem-solving skills, with the ability to interpret complex data and implement evidence-based strategies.

Strong leadership, communication, and interpersonal skills to inspire teamwork, influence stakeholders, and drive organizational change.

Proficiency in Microsoft Office Suite, EHR systems, and population health management software.

Working Conditions and Physical Requirements

Primarily an office-based role with occasional travel to hospitals, outpatient clinics, and community sites within the IDS.

Must be able to operate standard office equipment (computer, phone, copier, etc.).

Some evening or weekend work may be required to meet program deadlines or address urgent issues.

Application Process:

Interested candidates should submit a resume/CV via

Salary: $145,000-$175,000