The JobThe Director, Value-Based Care Network & Operations Strategy is responsible for developing and
implementing network and operational strategies that improve Total Cost of Care (TCoC). As the dyad
partner to the Senior Director, Clinical Programs, this role drives non-clinical affordability initiatives,
network optimization, and operational performance improvements that support value-based care goals.
You Will- TCoC Strategy & Program Leadership • Partner with Clinical Programs leadership to identify and execute TCoC improvement opportunities. • Lead non-clinical cost management programs,including Out-of-Area (OOA), CAR-T, transplant, and other high-cost care initiatives. • Partner with partner relations and member engagement teams to ensure effective provider and member engagement, and positive experience. • Monitor program performance and drive measurable financial impact.
- Network Strategy & Contracting • Lead network design, network sculpting, and specialty contracting initiatives. • Partner with Network Management to optimize provider and facility networks. • Identify opportunities to improve referral patterns, steerage, and cost efficiency.
- Operational Performance Improvement • Partner with Payment Integrity, Claims, and Operations teams to resolve operational issues impacting medical costs. • Address gaps such as: or Payments not aligned with contract terms o Authorization decisions not reflected in claims processing or Incorrect capitation and risk payment administration • Establish accountability and tracking for issue resolution.
- Cross-Functional Leadership • Collaborate with Clinical Programs, Finance, Analytics, Network Management, Member Experience, and Operations teams. • Lead strategic initiatives from opportunity identification through implementation. • Develop executive reporting and recommendations on TCoC performance.
- Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Supervisory Responsibilities Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN's Vision and Goals. Other duties as assigned.
Your Qualifications- 8+ years of experience in value-based care, healthcare operations, provider networks, managed care, or healthcare strategy.
- 5 years of leadership experience
- Bachelor's Degree or equivalent experience in in Healthcare Administration, Business, Finance, or
- related field.
- Strong knowledge of provider contracting, claims operations, payment methodologies, and healthcare
- economics.
- Medicare Advantage and value-based care experience preferred.
- Demonstrated success leading complex cross-functional initiatives
Competencies- Business Insight - In-Depth understanding of the business
- Problem Solving - Addresses complex, systemic issues and makes decisions with long-term departmental impact
- Strategic Mindset - Sets departmental direction, integrates cross-functional priorities, and creates strategies that support organizational advantage
- Communication - Communicates departmental strategy, influences senior stakeholders, and builds commitment across functions
Skills/Abilities- Ability to develop and execute value-based care, network optimization, and Total Cost of Care strategies.
- Strong knowledge of provider contracting, claims operations, payment methodologies, and
- undefined
- Ability to analyze complex operational and financial data, identify cost drivers, and translate findings into actionable recommendations.
- Demonstrated ability to lead complex cross-functional initiatives, influence stakeholders, and drive accountability for measurable outcomes.
What's in it for you?- Base Pay Range: $147,900 - $214,030 Salary + Incentive Plan
- Work Mode: Mostly Onsite
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
- Excellent 401(k) Retirement Saving Plan with employer match
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
