Associate Director, Provider Performance & Value Based Contracting

Associate Director, Provider Performance & Value-Based Contracting

Location: Birmingham, Alabama

Job Summary

The Associate Director, Provider Performance & Value-Based Contracting provides strategic and operational leadership supporting VIVA HEALTH’S value-based reimbursement strategy, provider performance initiatives, and Preferred Provider Network (PPN).

This position is responsible for implementing value-based contracting strategies, strengthening provider partnerships, advancing provider performance, and supporting innovative reimbursement models that improve quality, affordability, and member outcomes. Working collaboratively across Provider Services, Medical Economics, Finance, Clinical Operations, and other enterprise departments, this position translates organizational strategy into operational execution while identifying opportunities to improve provider performance and support VIVA HEALTH’S continued leadership in value-based care.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage


• 401(k) Savings Plan with company match and immediate vesting


• Paid Time Off (PTO)


• 9 Paid Holidays annually plus a Floating Holiday to use as you choose


• Tuition Assistance


• Flexible Spending Accounts


• Healthcare Reimbursement Account


• Paid Parental Leave


• Community Service Time Off


• Life Insurance and Disability Coverage


• Employee Wellness Program


• Training and Development Programs to develop new skills and reach career goals


• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Key Responsibilities

• Lead the implementation, administration, and continuous improvement of VIVA HEALTH’S value-based reimbursement strategies including shared savings, upside/downside risk arrangements, provider incentive programs, and other alternative payment models.


• Develop and maintain collaborative relationships with Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), hospitals, physician organizations, and other strategic provider partners to advance organizational objectives and improve provider performance.


• Lead the development of provider performance methodologies, scorecards, dashboards, and executive reporting in collaboration with the Network Operations & Analytics team by defining business requirements, key performance indicators, and actionable performance insights.


• Analyze provider performance across quality, utilization, cost, risk adjustment, member experience, and operational metrics. Translate findings into strategic recommendations that improve provider and organizational performance.


• Provide operational leadership for VIVA HEALTH’S Preferred Provider Network including provider selection methodologies, performance evaluation, governance activities, network optimization, and expansion into additional provider categories.


• Identify and recommend innovative provider contracting strategies, reimbursement models, preferred provider initiatives, and performance improvement opportunities that strengthen provider partnerships and advance value-based care objectives.


• Coordinate provider performance reviews, Joint Operating Committee meetings, contract reconciliations, and other activities supporting value-based provider partnerships.


• Develop executive presentations, business cases, and strategic recommendations for senior leadership, provider organizations, and governing committees.


• Monitor healthcare industry trends, regulatory changes, and emerging payment models to identify opportunities for innovation and continuous improvement.


• Provide leadership and mentorship for assigned staff, project teams, and strategic initiatives.


• Travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured in accordance with Company policy.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Economics, Public Health, Health Informatics, Information Systems, or a related field


• 7 years progressively responsible experience in managed care, provider contracting, provider network management, value-based care, healthcare consulting, provider performance, medical economics, or a related healthcare leadership role


• 3 years progressive leadership or management experience


• Strong knowledge of value-based reimbursement methodologies, provider economics, healthcare payment models, Medicare Advantage, quality measurement, utilization management, risk adjustment, and provider performance improvement strategies


• Strong analytical, financial, and strategic thinking skills with the ability to evaluate complex healthcare data, develop provider performance methodologies, define key performance indicators, and translate findings into actionable business recommendations


• Demonstrated ability to build collaborative relationships and influence executive leadership, physicians, hospitals, provider organizations, and cross-functional business partners to achieve strategic objectives


• Excellent communication, presentation, negotiation, and relationship management skills with the ability to communicate effectively across technical and non-technical audiences


• Demonstrated ability to influence organizational strategy through collaboration, innovation, consensus building, and data-informed decision-making


• Strong organizational and project management skills with the ability to prioritize competing initiatives, manage multiple strategic projects, and consistently deliver high-quality results


• Proficiency with Microsoft Office applications, including Excel, PowerPoint, and Word


• Valid driver's license in good standing

PREFERRED QUALIFICATIONS:

• Master’s degree in Healthcare Administration (MHA), Business Administration (MBA), Public Health (MPH), or a related discipline


• Experience working with physician organizations, hospitals, ACOs, CINs,
  integrated delivery systems, or provider-sponsored health plans


• Six Sigma Green Belt or higher


• Deep knowledge of Medicare Advantage value-based reimbursement methodologies, alternative payment models, provider incentive structures, shared savings arrangements, upside/downside risk models, and other value-based reimbursement strategies


• Knowledge of Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), provider-sponsored health plans, integrated delivery systems, physician practice operations, and provider network strategy


• Knowledge of provider performance methodologies, executive dashboards, scorecard development, enterprise performance reporting, healthcare analytics, and business intelligence reporting solutions


• Working knowledge of SQL, Power BI, Tableau, or other business intelligence tools sufficient to define business requirements, interpret analytical outputs, and support data-informed decision making (technical
  programming expertise not required)


• Strong understanding of healthcare finance, provider reimbursement methodologies, medical economics, and financial performance analysis


• Ability to lead cross-functional strategic initiatives involving Provider Services, Finance, Medical Economics, Clinical Operations, Analytics, and executive leadership


• Ability to identify opportunities for innovation, evaluate emerging reimbursement strategies, and translate strategic objectives into operational execution