Director, Cost of Care Performance
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Job Description
Director of Cost of Care Performance at Pearl Health driving cost reduction strategies in value-based care. Leading operational programs and partnerships with a focus on healthcare performance improvement.
Responsibilities:
- Drive the roadmap for operational programs and partnerships that reduce unnecessary spend and utilization and improve care delivery across Pearl’s provider network.
- Partner with Data Science, Product, and Customer Success to size and prioritize strategic opportunities that impact total cost of care.
- Translate insights into scalable operational tactics that improve patient outcomes, decrease wasteful spending, and enhance provider experience.
- Lead efforts to identify, investigate, and mitigate fraud, waste, and abuse (FWA) — ensuring our processes uphold integrity and quality across the network.
- Develop and manage strategic vendor partnerships that advance Pearl’s total cost of care and utilization management objectives.
- Partner with Product and Growth teams to transform provider feedback and market learnings into product enhancements and operational improvements.
- Collaborate with Customer Success to design, roll out, and optimize provider incentive and engagement programs.
- Champion provider education through clear communication materials, guides, and training sessions that support success in value-based care models.
Requirements:
- Bachelor’s degree required; advanced degree (MHA, MBA, MPH, or related) preferred.
- 8+ years of experience in healthcare operations, value-based care, or health plan management.
- 5+ years of leadership experience managing cross-functional teams and high-impact initiatives.
- Deep understanding of total cost of care, utilization management, and value-based care models.
- Proven success translating analytical insights into operational strategy and measurable results.
- Experience with Medicare and/or Medicaid programs, including CMS regulations and CMMI models.
- Demonstrated experience managing vendors and external partnerships to drive performance.
- Strong communication and stakeholder management skills across clinical, technical, and business teams.
Benefits:
- We offer a competitive benefits package. More on our careers page.
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