Director of Value Base Network Operations
Company Description
PWG Consults is a consulting organization focused on helping clients optimize their operations, technology, and network performance to achieve measurable business results. The company partners with healthcare organizations, payers, and other value-based care stakeholders to design, implement, and manage effective network strategies. PWG Consults emphasizes data-driven decision-making, operational excellence, and collaborative problem-solving. Team members work in a dynamic environment that values professional growth, innovation, and client impact. Role Description The Director of Value Based Network Operations is a senior leadership role responsible for overseeing the design, execution, and performance of value-based care (VBC) programs across the Texas provider network. This leader will serve as the primary operational architect for VBC contracting strategies, network performance, quality outcomes, and financial stewardship — working cross-functionally with clinical, finance, analytics, and payer relations teams to drive meaningful improvements in cost, quality, and patient experience. This role is ideal for a healthcare leader with deep expertise in managed care, ACO/IPA operations, MSSP/REACH, Medicare Advantage, or commercial risk arrangements — and a track record of leading high-performing teams in a complex, multi-payer environment.
Key Responsibilities
Network Strategy & Operations Lead day-to-day operations of the value-based care network across Texas markets, ensuring providers meet contractual quality, utilization, and financial performance targets. Develop and implement network infrastructure, workflows, and governance models that support VBC program success. Partner with payers, ACOs, IPAs, and health systems to align on shared savings, risk arrangements, and contract performance goals. Oversee network adequacy, provider onboarding, and engagement strategies to ensure a high-performing, compliant provider panel. Value-Based Contract Management Manage a portfolio of value-based contracts including Medicare Advantage, MSSP/ACO REACH, Medicaid Managed Care, and commercial shared savings arrangements. Monitor and report on financial performance against risk corridors, quality benchmarks, and utilization targets. Collaborate with actuarial, finance, and analytics teams to model financial risk and opportunity across VBC contracts. Identify and escalate contract risks and lead corrective action plans in partnership with provider relations. Quality & Clinical Performance Drive HEDIS, STARS, and other quality measure performance improvements across the network. Partner with clinical leadership to embed evidence-based care protocols and population health interventions into network operations. Oversee chronic disease management, preventive care compliance, and care gap closure initiatives. Lead annual quality improvement planning and reporting to internal stakeholders and payer partners. Analytics & Reporting Utilize data and analytics platforms to monitor provider performance, identify trends, and surface actionable insights. Develop and present executive-level performance dashboards, scorecards, and quarterly business reviews. Support the development of predictive models and risk stratification tools to proactively manage high-risk populations. Leadership & Team Development Lead and mentor a team of VBC operations managers, network analysts, care coordinators, and provider engagement specialists. Foster a culture of accountability, continuous improvement, and data-driven decision making. Directly manage and develop a team of VBC operations managers, network performance staff, care coordinators, and provider engagement specialists, setting clear performance expectations and fostering a high-accountability culture. Collaborate closely with Medical Directors to identify underperforming practices, co-develop performance improvement plans, and drive clinical and operational initiatives that reduce cost of care and improve patient outcomes. Partner with Medical Directors to align cost-saving strategies with quality improvement priorities, ensuring initiatives are clinically grounded and operationally executable across the provider network. Oversee the quarterly POD meeting program across the provider network, ensuring meetings are structured, data-driven, and produce accountable action plans; direct the Network Performance Manager in coordinating logistics, agendas, and follow-up tracking. Represent the organization in external stakeholder forums, payer meetings, and state/regional healthcare coalitions.
Qualifications
Required Bachelor's degree in Healthcare Administration, Business, Public Health, Nursing, or a related field. 7–10+ years of progressive experience in healthcare operations, managed care, or value-based care. Minimum 3–5 years in a leadership/director role managing teams and cross-functional programs. Demonstrated experience managing VBC contracts (Medicare Advantage, MSSP, REACH, Medicaid risk, commercial shared savings). Deep understanding of healthcare quality metrics: HEDIS, STARS, NPS, CAHPS, cost-of-care measures. Proficiency in healthcare data analytics tools (e.g., Arcadia, Work En v ironment & Travel Primary location: Texas (Houston, Dallas, Austin, or San Antonio preferred). Hybrid work model typical; on-site presence required for provider meetings, network events, and payer negotiations. Travel within Texas approximately 20–35% depending on market footprint. Some evening or weekend availability required for board presentations, network events, or payer forums. Apply tot his job Apply To this Job