Director-Provider Services-Health Plan (remote/hybrid)

Location Address: 9521 San Mateo NE
Albuquerque, NM 87113-2237
 Summary: The Director of Provider Network Servicing and Value-Based Payments is a senior leadership role responsible for the strategic oversight, performance, and integration of provider servicing operations and value-based payment (VBP) programs across all lines of business. This role ensures a high-performance provider network by driving operational excellence in provider engagement, issue resolution, and education, while advancing the transition to value-based care through effective program design, implementation, and performance management. The position partners closely with Provider Contracting, Medical Economics, Clinical Operations, and Finance to optimize total cost of care, improve quality outcomes, and strengthen provider relationships. Work Arrangement • Remote: Open to applicants in the United States, excluding IL, ND, NY, WA, and WY. • Hybrid (Strongly Preferred): For individuals within 60 miles of Albuquerque, in-office presence is required Tuesday through Thursday. Job Description: Responsibilities • Lead all aspects of provider servicing operations, including issue resolution, provider education, and ongoing relationship management. • Serve as the escalation point for complex provider issues, ensuring timely resolution and root-cause remediation. • Establish standardized servicing models, workflows, and performance expectations across servicing teams. • Collaborate on provider communication strategies, including outreach, training, and engagement initiatives. • Lead cross-functional efforts to resolve systemic provider issues involving claims, configuration, and payment accuracy. • Provide strategic leadership for value-based payment programs, including shared savings, capitation, pay-for-performance, and alternative payment models. • Oversee design, implementation, and ongoing optimization of VBP arrangements across key provider segments (e.g., primary care, large systems, specialists). • Partner with Medical Economics to develop financial models, performance benchmarks, and incentive methodologies. • Ensure alignment between contracting strategies and value-based program objectives. • Drive provider adoption and maturation along the value-based continuum through education, analytics, and performance reporting. • Establish performance measurement framework for provider quality, utilization, and total cost of care. • Oversee development of provider-facing dashboards and internal reporting to monitor VBP and network performance. • Leverage data analytics to inform provider engagement strategies and financial optimization opportunities. • Oversee implementation and monitoring of payment models, ensuring accurate configuration and performance tracking. • Evaluate financial performance of contracts and VBP programs, including impact on Medical Cost Ratio (MCR) and trend. • Support negotiation strategy by providing insights on provider performance and operational risks. • Ensure all provider servicing and VBP activities comply with federal, state, and accreditation requirements (e.g., CMS, Medicaid, NCQA). • Support regulatory reporting and audits related to provider network operations and value-based arrangements. • Maintain policies and procedures governing provider servicing and VBP operations. • Build and maintain strategic relationships with key provider organizations and executive stakeholders. • Lead Joint Operating Committees (JOCs) and provider governance forums. • Serve as a senior liaison between the health plan and provider community. • Drive continuous improvement in provider servicing workflows, tools, and technology platforms. • Partner with IT and analytics teams to enhance provider data, reporting, and automation capabilities. • Lead transformation initiatives linking provider servicing with population health and clinical operations. • Lead and develop high-performing