The Director leads initiatives for optimizing provider network performance, manages network relationships, oversees performance data analytics, and fosters collaboration in value-based care settings.
InnovaCare Services Company, LLCJob Summary The Director of Provider Network Performance is a strategic leadership role responsible for optimizing the performance of the provider network across clinical, financial, and operational domains. This individual will lead initiatives that improve quality outcomes, reduce medical costs, and enhance provider engagement within value-based care arrangements. The role requires a deep understanding of healthcare delivery systems, risk-based contracting, and performance analytics. In addition, in this role, the individual will manage and oversee our preferred provider network.Essential Job Functions
- Develop and execute strategies to improve provider performance under value-based contracts (e.g., ACO, Medicare Advantage, Medicaid Managed Care).
- Lead the design and implementation of performance frameworks, including scorecards, dashboards, and incentive models.
- Collaborate with executive leadership to align network performance goals with organizational objectives.
- Serve as the primary liaison for high-performing and underperforming provider groups.
- Facilitate Joint Operating Committees (JOCs), performance reviews, and strategic planning sessions with provider leadership.
- Build trust-based relationships with providers to foster collaboration and accountability.
- Oversee the development and interpretation of performance data, including cost, utilization, quality metrics, and patient outcomes.
- Partner with analytics teams to identify trends, gaps, and opportunities for improvement.
- Present actionable insights to internal stakeholders and external partners.
- Collaborate with clinical teams to support care coordination, chronic disease management, and population health initiatives.
- Ensure alignment between clinical protocols and network performance goals.
- Support implementation of evidence-based interventions and care pathways.
- Ensure provider adherence to contractual obligations, including quality benchmarks, documentation standards, and reporting requirements.
- Monitor compliance with CMS, NCQA, and state regulatory guidelines.
- Mitigate financial and operational risks through proactive oversight and intervention.
- Lead a multidisciplinary team including Provider Performance Managers, Clinical Liaisons, and Data Analysts.
- Foster a culture of accountability, innovation, and continuous improvement.
- Provide coaching, mentorship, and professional development opportunities.
- Bachelor’s degree in Healthcare Administration, Public Health, Business, or related field (required).
- Master’s degree (MBA, MHA, MPH) strongly preferred.
- Minimum 7–10 years of experience in healthcare network management, provider relations, or population health.
- Proven track record of leading performance improvement initiatives in a value-based care setting.
- Deep understanding of healthcare economics, risk adjustment, and payment models.
- Strong analytical skills with proficiency in data visualization tools (e.g., Tableau, Power BI).
- Exceptional communication and negotiation skills.
- Ability to manage complex projects and cross-functional teams.
- Knowledge of EMR systems, claims data, and clinical workflows.
- Experience with ACOs, CINs, or delegated provider groups.
- Clinical background (e.g., RN, NP, PA) is a plus.
- Proficiency in healthcare analytics tools and Excel.
- Hybrid or remote work environment with occasional travel to provider sites and regional offices.
- Travel requirement: up to 50%.
Top Skills
Emr Systems
Healthcare Analytics Tools
Excel
Power BI
Tableau
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