Description

Job Summary:

The Executive Director of the Long-term Enhanced ACO Design (LEAD) Model provides strategic, operational, financial, and clinical leadership for the organization's participation in the CMS Innovation Center's LEAD Model and its broader accountable care initiatives. This executive is responsible for the development, implementation, and performance of value-based care strategies that improve quality outcomes, patient experience, provider engagement, and total cost of care for aligned Medicare beneficiaries, with particular focus on high-needs and dually eligible populations.

LEAD is a voluntary, 10-year CMS Innovation Center model (performance years [redacted]) and the designated successor to ACO REACH. The Executive Director leads the organization's readiness for the January 1, 2027 go-live and its sustained performance across the life of the model.

Reporting directly to the Chief Operating Officer (COO), the Executive Director serves as the organization's primary operational leader for ACO activities and collaborates closely with physicians, clinical leadership, finance, population health, care management, network development, compliance, information technology, and strategic partners. The Executive Director works in partnership with the ACO governing body and senior executives to ensure achievement of strategic objectives and regulatory compliance.

The position requires a strong understanding of Medicare value-based payment models, prospective and population-based payment mechanics, benchmarking methodology, population health management, quality improvement, risk adjustment, care coordination, physician alignment, and healthcare financial performance.

Our team members enjoy the following benefits: Competitive salaries and a comprehensive benefit package which includes paid time off (PTO), seven paid holidays, medical, dental, vision, disability, and life insurance, and 403B match after 12 months of service. Other benefits include mileage reimbursement, flexible work schedules, professional growth and development opportunities, and employee engagement activities.

Requirements

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Education and Experience:
• Bachelor's degree in Healthcare Administration, Business or Public Administration, Public Health, or Nursing
• Master's degree in Healthcare Administration (MHA), Business or Public Administration (MBA or MPA), Public Health (MPH), Nursing, or related field strongly preferred.
• Minimum of seven (7) years of progressive leadership experience in healthcare operations, population health, managed care, value-based care, or accountable care organizations.
• Minimum of five (5) years of senior leadership experience with responsibility for strategic and operational outcomes.
• Demonstrated experience managing Medicare value-based care models, including ACO REACH, GPDC/Direct Contracting, MSSP, Medicare Advantage, or similar risk-based arrangements.
• Experience working directly with boards, governing bodies, and executive leadership teams.
• Proven track record of improving quality performance, patient outcomes, and financial results.

Key Responsibilities:

Strategic Leadership

• Lead the overall strategy, implementation, and execution of the organization's LEAD Model participation and ACO operations.
• Direct the organization's LEAD Model onboarding and, where applicable, the transition from ACO REACH or other prior CMS accountable care models.
• Develop and execute annual and multi-year strategic, operational, financial, and quality plans aligned with organizational goals and the model's 10-year horizon.
• Identify opportunities to improve clinical outcomes, financial performance, member experience, and provider engagement.
• Advance care coordination for high-needs and dually eligible beneficiaries, including Medicare-Medicaid integration opportunities available under the model.
• Establish and maintain collaborative relationships with payer partners, community organizations, and participating providers.

ACO Operations Oversight

• Provide executive oversight of all ACO functions, including care coordination, quality improvement, risk management, analytics, compliance, provider engagement, and beneficiary services.
• Monitor and drive performance against key quality, utilization, financial, and patient experience metrics.
• Ensure effective implementation of care delivery models that support value-based care objectives.
• Oversee operational readiness and ongoing execution of LEAD Model requirements, including beneficiary alignment, benefit enhancements, and reporting obligations.
• Lead efforts to manage total cost of care, reduce unnecessary utilization, and improve care outcomes.

Financial Performance and Value-Based Care

• Accountable for ACO financial performance under the model's risk arrangements, including capitated and population-based payment options, benchmark performance, and quality-linked incentives.
• Develop and execute the organization's benchmarking and risk-option strategy across the life of the model.
• Collaborate with finance leadership to develop budgets, forecasts, capitation and reconciliation modeling, and performance reporting.
• Analyze financial and utilization trends to identify opportunities for improvement.
• Recommend and implement corrective action plans when performance objectives are not being achieved.
• Support the expansion and long-term sustainability of the organization's value-based care portfolio.

Governance and Board Engagement

• Serve as the primary staff liaison to the ACO governing body and its committees.
• Ensure the governing body's composition and operations meet LEAD Model requirements, including beneficiary and consumer-advocate representation, provider-control provisions, and conflict-of-interest policies.
• Collaborate with governance leadership to establish organizational priorities and strategic goals.
• Prepare and present regular reports regarding clinical quality, financial performance, operational metrics, compliance, and strategic initiatives.
• Facilitate board and committee meetings, including agenda development, action planning, and follow-up.
• Provide recommendations to leadership and governing bodies regarding policy, strategy, and program performance.

Quality and Clinical Performance

• Partner with physician and clinical leaders to improve performance on Medicare quality measures and patient outcomes.
• Promote evidence-based clinical practices and care management programs.
• Oversee quality improvement initiatives aimed at reducing variation and improving patient-centered care.
• Support risk adjustment strategies, preventive services, chronic disease management, and transitions of care programs.
• Foster a culture of continuous improvement and accountability throughout the organization.

Regulatory Compliance and Risk Management

• Ensure compliance with CMS regulations, LEAD Model participation agreements and requirements, and applicable federal and state regulations.
• Oversee program audits, monitoring activities, and corrective action plans.
• Partner with legal, compliance, and privacy leaders to maintain program integrity.
• Ensure accurate and timely reporting of required performance and compliance measures.

Provider and Network Engagement

• Build and maintain strong relationships across a network of participating physicians, advanced practice providers, hospitals, post-acute, and ancillary providers.
• Support recruitment and integration of small, independent, and rural practices and specialists, consistent with the model's participation goals.
• Foster physician and advanced practice provider engagement in value-based care initiatives and performance improvement efforts.
• Communicate organizational goals, expectations, and performance results to stakeholders.
• Support provider education related to quality, utilization management, population health, and financial performance.

Beneficiary Engagement

• Oversee voluntary alignment and beneficiary engagement strategies.
• Direct implementation of beneficiary enhancements and benefit flexibilities available under the model.
• Ensure beneficiary communications, incentives, and protections meet model requirements.