Value Based Director

Value Based Director Company: Triple-S Salud Job Location (Short): Guaynabo, PR Posting Start Date: 10/29/26 JOB SUMMARY Strategic leader responsible for designing, implementing, and scaling the value-based transformation strategy across Specialty Practices. The Director serves as a strategic partner to providers, translating performance data and value-based contract objectives into actionable practice transformation initiatives that improve quality, total cost of care, patient outcomes, provider experience, and financial performance. ESSENTIAL FUNCTIONS • Establish the operating model, methodology, standards, and performance framework in alignment with organizational priorities and value-based contract objectives. • Establish a trusted-advisor relationship with physicians and practice leadership creating a provider-centric transformation experience based on transparency, collaboration, and shared accountability. • Lead interventions addressing clinical workflows, access and capacity, care coordination, referral management, patient engagement, documentation and coding, risk adjustment, revenue cycle, HER optimization and office staff capabilities. • Develop and oversee provider performance management using: HEDIS, STAR Ratings, CMS measures, Risk Adjustment / RAF, Total Cost of Care, PMPM, Utilization, Readmissions, ED utilization, Medication adherence, Patient experience & Provider experience. • Establish provider segmentation and differentiated intervention strategies based on performance and opportunity. • Partner with Medical Management, Analytics, Finance, Pharmacy, and providers to identify opportunities involving: avoidable admissions, emergency department utilization, readmissions, high-cost members, imaging utilization, procedure variation, site-of-care optimization, referral leakage, centers of excellence, specialty pharmacy & therapy optimization • Partner with Pharmacy and clinical teams to identify opportunities related to: Specialty drug utilization, Biosimilars, Formulary adherence, Medication adherence, Infusion site optimization, Prior authorization, Appropriate therapy utilization & Cost-effective alternatives. • Partner with Contracting and Finance to translate contract requirements into provider action plans, monitor incentive performance, support provider understanding of value-based economics, identify opportunities for shared savings, evaluate performance against quality and cost targets, support provider readiness for new value-based arrangements & connect transformation activities to financial outcomes. • Establish the operating standards for Value-Based Transformation Consultants, including: provider assignment, visit methodology, practice assessment, performance review, intervention planning, resource coordination, escalation, follow-up & documentation • Create an integrated resource model connecting providers with: Medical Directors, Quality, Population Health, Care Management, Pharmacy, Network Management, Provider Relations, Practice Management, Risk Adjustment, Coding/CDI, Analytics, Finance, IT/Digital & Compliance. EDUCATION • Master's Degree in Public Health or Health Services Administration • Bachelor's Degree in Public Health or Health Services Administration EXPERIENCE Master's degree, preferred, in a healthcare-related field such as Master of Public Health or Master of Health Administration. Or, bachelor's degree in a healthcare-related or analytical field such as: Public Health, Health Administration, Nursing, Pharmacy, Health Sciences, Business Administration (with healthcare experience), Economics or Data Analytics (with healthcare exposure). LICENSES AND CERTIFICATIONS • None required COMPETENCIES • Customer Delight • Financial & Business Acumen • One Company Mindset • Practical Knowledge in Tech • Data Driven Insights