Director, Provider Performance

About this role

Job Description Must be located in North Jersey OR New York

A bit about this role....

As the Director, Network Performance, you will establish and execute the strategic direction for provider performance across New York City. Your primary accountability is to achieve sustained improvements in cost, quality, and access by leveraging strong leadership, influencing provider strategy, and driving critical, enterprise-level performance initiatives.

This is a senior leadership position where you will lead and mentor a team of Network Performance Managers and Senior Network Performance Managers, fostering consistent execution and elevating team capabilities. You will act as a vital strategic partner to executive leadership and external provider organizations. Success in this role requires influencing performance outcomes through deep provider engagement, strategic contracting, and data-driven insights.

The ideal candidate is an highly experienced leader who possesses advanced business acumen, a strong executive presence, and the proven ability to translate complex analytics into scalable strategies that deliver measurable results across the organization.

Responsibilities and Impact Include: • Enterprise & Regional Performance Strategy • Define and lead the provider performance strategy across New York City

• Establish performance targets and ensure accountability for cost, quality, and access outcomes

• Identify enterprise-level opportunities to improve provider performance and drive scalable solutions

• Align market-level strategies with broader organizational goals and growth initiatives

• Provider Performance & Executive Engagement • Build and maintain executive-level relationships with key health systems, provider groups, and strategic partners

• Serve as a senior escalation point for complex provider performance issues and negotiations

• Lead high-level performance reviews and Joint Operating Committees (JOCs) with major provider partners

• Influence provider strategy and behavior to align with organizational performance objectives

• Leadership & Team Development • Lead, coach, and develop a team of Network Performance Managers and Senior Network Performance Managers

• Establish clear performance expectations and foster a culture of accountability and continuous improvement

• Build organizational capability in provider performance, analytics, and strategic execution

• Drive consistency in performance management practices across markets

• Performance Analytics & Transformation • Owns outcomes and drives measurable improvements in cost, quality, and access

• Oversee the use of advanced analytics to identify trends, risks, and opportunities across markets, leveraging AI-driven prompts  with a strong emphasis on advanced AI tools.

• Drive large-scale performance improvement initiatives, including cost containment and quality enhancement programs

• Ensure consistent use of data to inform decision-making and track performance outcomes

• Champion innovation in performance models, including value-based and risk-based arrangement

• Contracting Strategy & Financial Performance • Provide strategic oversight of provider contracting to ensure alignment with performance goals

• Guide development of value-based arrangements that incentivize quality and cost efficiency

• Partner with Finance and Actuarial teams to evaluate financial performance and optimize network economics

• Governance, Compliance & Risk Management • Ensure all provider performance activities meet regulatory, contractual, and compliance requirements

• Oversee risk identification and mitigation strategies across markets

• Maintain executive visibility into compliance, performance risks, and corrective actions

• Cross-Functional Leadership & Organizational Impact • Partner with Clinical, Quality, Operations, and Finance leadership to drive integrated performance strategies

• Influence enterprise decision-making related to provider performance and network strategy

• Support market expansion, strategic planning, and organizational growth initiatives

• Represent provider performance in executive forums and strategic discussions

• Develops high-performing teams through coaching, mentorship, and clear expectations

Required skills and experience: • Minimum of 10 years of experience in provider performance, network management, or provider contracting

• Minimum of 5 years of leadership experience managing high-performing teams

• Demonstrated success driving large-scale provider performance improvement across cost and quality metrics

• Deep experience working with health systems, physician groups, and complex provider organizations

• Advanced analytical capabilities with a track record of translating data into enterprise-level strategies

• Proven ability to influence executive stakeholders internally and externally

• Strong business acumen, including expertise in payer economics, provider incentives, and market dynamics

• Demonstrated history of successfully executing large-scale initiatives to improve provider performance across key cost and quality metrics.

• Proven capacity to influence and negotiate with executive-level stakeholders, both within the organization and externally.

• Strong understanding of business fundamentals, including expertise in payer economics, provider incentive models, and broader market dynamics.

• Proficiency in Google Workspace or Microsoft Office Suite

• Strong written and oral communication skills

Desired skills and experience: • Experience in Medicare Advantage or government-sponsored healthcare programs

• Deep knowledge of CMS STAR measures and value-based care models

• Experience leading multi-market or regional provider performance strategies

• Advanced degree (MBA, MHA, MPH, or related field)

• Background in clinical operations, population health, or healthcare delivery

Travel Requirements This role requires approximately 10% travel to assigned markets. Travel i

Similar jobs

• Director, Provider Operations — Khealthcareers · New York, NY
• Director, Provider Operations — Oscar · Tempe, Arizona, United States
• Director, Provider Operations — Oscar · New York, New York, United States
• Director, Provider Operations — Oscar · Remote
• Director, Provider Operations — Oscar · Remote
• Director, Performance Improvement — Healthfirst · Hybrid - NY
• Director, Provider Network Operations — PacificSource · Portland, OR
• Director, Provider Network Operations — PacificSource · Bend, OR