Full-Time

Senior Director Value Based Care Strategy & Operations

Martin's Point Health Care

Martin's Point Health Care

501-1,000 employees

Not-for-profit health care organization

No salary listed

No H1B Sponsorship

Portland, ME, USA

In Person

Category
Business & Strategy (1)
Required Skills
Risk Management
Financial Modeling
Requirements
  • Bachelor’s degree in healthcare administration, business, public health, finance or related field
  • Master’s degree (MBA, MHA, MPH, or related field strongly preferred)
  • 10 years of progressive experience in healthcare strategy, value-based care, population health, payer-provider contracting, or related complex healthcare environments, including leadership of cross-functional teams and multi department initiatives
  • Healthcare payment models including Medicare Advantage, ACOs, shared risk, and capitated arrangements
  • Population health strategy and performance measurement
  • Healthcare economics, reimbursement methodologies, and regulatory environments
  • Governance, risk management, and organizational policy development
  • Advanced strategic planning and operational execution
  • Financial modeling and budget management
  • Executive-level presentation and communication skills
  • Contract negotiation and stakeholder influence
  • Performance management system development
  • Ability to lead complex, multi-department initiatives with significant financial and operational impact
  • Ability to make high-impact decisions with long-term organizational consequences
  • Ability to influence senior leaders and external stakeholders
  • Ability to anticipate risk and drive proactive solutions
  • Ability to act independently within broad organizational objectives
Responsibilities
  • Develops and executes comprehensive, multi-year value-based care strategies that align with enterprise goals and drive improved clinical outcomes, patient experience, equity, and financial performance
  • Translates enterprise strategy into operational plans with defined milestones, KPIs, governance structures, and accountability mechanisms across multiple departments and divisions
  • Leads the design, implementation, and optimization of value-based payment models (e.g., ACOs, shared savings, bundled payments, capitation, risk-based arrangements) to achieve quality, utilization, and financial targets
  • Establishes and oversees performance management frameworks, dashboards, and reporting systems to monitor quality, utilization, risk adjustment, cost, and compliance outcomes
  • Oversees multiple functional areas and cross-department workstreams, coordinating clinical, operational, financial, analytics, compliance, and contracting resources to ensure successful program delivery
  • Develops and manages departmental budgets and cost centers, ensuring responsible stewardship of financial, human, and operational resources
  • Identifies enterprise-level risks, implements mitigation strategies, and escalates significant issues appropriately to protect strategic, operational, and financial objectives
  • Develops, interprets, executes, and recommends modifications to organizational policies and procedures that support value-based care transformation and regulatory compliance
  • Serves as the primary organizational representative for senior-level internal and external stakeholders, including health systems, payers, providers, employers, and community partners
  • Leads negotiations and contractual strategy for payer-provider arrangements and risk-based agreements, ensuring alignment with organizational financial and quality goals
  • Accomplishes results through Directors, Managers, and other leaders by establishing effective organizational structures, supervisory relationships, performance expectations, and accountability standards
  • Provides full leadership accountability including hiring, performance management, succession planning, talent identification, and leadership development
  • Drives organizational adoption of value-based care principles through education, change management strategies, and cross-functional collaboration
  • Promotes a culture of accountability, continuous improvement, innovation, and alignment with the organization’s mission, vision, and core values
Desired Qualifications
  • Master’s degree (MBA, MHA, MPH, or related field strongly preferred)
Martin's Point Health Care

Martin's Point Health Care

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Martin's Point Health Care is a not-for-profit health care organization that provides medical services to individuals and families. Its offerings include a range of primary and specialty care delivered through clinics and care teams, with a focus on coordinated, accessible patient care and preventive services. The company reinvests profits back into the organization to improve care, expand community benefits, and keep services affordable. Unlike for-profit competitors, it emphasizes community health impact and long-term patient relationships, supported by a mission-driven, member- or patient-centered approach. The goal is to improve the health of the communities it serves by delivering high-quality, affordable care and reinvesting earnings to enhance services and access.

Company Size

501-1,000

Company Stage

N/A

Total Funding

N/A

Headquarters

Portland, Oregon

Founded

1981

Simplify Jobs

Simplify's Take

What believers are saying

  • Avoided litigation costs and uncertainty through July 2023 DOJ settlement.
  • Whistleblower award of $3.82M incentivizes internal compliance reporting.
  • DOJ settlement deters competitors from similar Medicare Advantage upcoding practices.

What critics are saying

  • DOJ launches post-2019 False Claims Act probes using Wilbur precedent within 6-12 months.
  • CMS 2024 model cuts reimbursements by validating fewer diagnosis codes in 3-6 months.
  • New whistleblowers sue over DxID vendor HCC additions, penalties exceed $22M in 12-18 months.

What makes Martin's Point Health Care unique

  • Martin's Point operates Medicare Advantage plans in Maine and New Hampshire.
  • Settled $22.48M DOJ False Claims Act case in July 2023 without admitting liability.
  • Whistleblower Alicia Wilbur filed qui tam suit in 2018 exposing risk adjustment issues.

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Benefits

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Company News

PR Newswire
Jul 31st, 2023
Martin'S Point Health Care Risk Adjustment Settlement

PORTLAND, Maine, July 31, 2023 /PRNewswire/ -- Today, Martin's Point Health Care announced that it has agreed to a settlement with the U.S. Department of Justice (DOJ) to resolve an investigation related to Martin's Point's Risk Adjustment practices for the payment years 2016-2019. The claims resolved by the settlement are allegations only, and there has been no determination of liability. The settlement is not related to member care or the payment of member claims.Martin's Point worked collaboratively with the DOJ during the course of the investigation. Despite denying liability for the litigation claims at issue, Martin's Point ultimately determined that settlement of this matter was appropriate rather than engaging in the cost and uncertainty of protracted litigation.A spokesperson for the organization commented: "This settlement is not an admission of liability, it instead allows us to avoid the disruption, expense, and uncertainty of litigation. It is important to note that this investigation is unrelated to member care or payment of member claims