Lead Director, Provider Value- Care

Position Summary

Lead Director of Value‑Based Contracting establishes and maintains productive value‑based relationships with key network providers. Responsible for developing and managing the Keystone Value‑Based Network, building strategic relationships with provider partners to develop innovative value‑based solutions to meet total cost and quality goals.

• Develop alternative payment models, identify and plan new initiatives, and negotiate high‑value/risk contracts with complex arrangements.
• Understand providers’ volume and cost structure, and work cross‑functionally to identify levers and critical negotiation points, aligning strategies with network accessibility, quality, compliance, and financial performance goals.
• Lead the complete value‑based contracting cycle from planning, creating documents, negotiation and loading of executed arrangements.
• Collaborate with the Performance, Clinical Transformation, VBS Analytics, and other internal teams to develop strategic plans and oversee contract performance with targeted provider groups.
• Elicit and provide support to other departments for required provider information (HEDIS, credentialing, grievance, SIU, etc.) and coordinate provider status information with member services.
• Lead complex projects/programs from assessment to implementation, impacting multiple processes, systems, functions, and products across all lines of business.
• Facilitate and attend external provider meetings and negotiations as needed.

• 10 years of related experience and a comprehensive level of negotiating skills with a successful track record negotiating value‑based contracts with IPAs, large complex provider systems or groups, hospitals, and large physician entities.
• Experience reviewing medical claims data and developing executive summaries to identify opportunities for mitigating medical cost trends.
• Excellent analytical, problem‑solving, communication, negotiation, and presentation skills.
• Ability to work in a matrixed organization, gain consensus, and share information with various stakeholders.

• Familiarity with legal terms in the context of provider contracting.
• Knowledge of CMS Stars, HEDIS technical specifications, and associated measurable percentiles.
• Experience with Commercial, Medicare, and Medicaid contracting.
• Ability to apply systems thinking when managing multiple provider value‑based initiatives.
• Strong financial modeling background.
• Bachelor’s degree or equivalent combination of professional work experience and education.

Typical pay range: $ – $ annually. Base pay depends on experience, education, geography, and other factors. The position is eligible for bonus, commission, short‑term incentive, and an equity award program.

Eligible for a comprehensive benefits package including medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.