Director of ACO Population Health

Director of ACO / Population Health Location: Massachusetts (On-site / Hybrid) About the Role A mission-driven community health organization is seeking a Director of Population Health to lead and advance care management programs that serve our most vulnerable patients. If you are a clinical leader who believes deeply in health equity, value-based care, and improving outcomes for underserved communities, this is an opportunity to shape population health strategy from the ground up. In this role, you will oversee a multidisciplinary care management team embedded across primary care practices, ensuring every patient benefits from coordinated, whole-person care. You will use data to drive decisions, close gaps in care, and design programs that meet people where they are, including those facing complex social and behavioral health needs. This is a high-impact leadership role within an Accountable Care Organization (ACO) environment, ideal for someone passionate about reducing disparities and building care models that truly serve the community. What You'll Do Provide oversight to the care management team and ensure all team members are clinically integrated into local primary care practices, optimizing their role within the Patient-Centered Medical Home (PCMH) model. Partner with community support and social services teams to align Social Determinants of Health (SDOH) strategies and grant-funded care management programs. Align behavioral health care management strategies with the behavioral health clinical service line, engaging behavioral health leadership in reviewing complex cases. Collaborate with site Medical Directors, clinical leadership, and the Chief Medical Officer to ensure physician involvement in clinical initiatives where appropriate. Use data analytics to evaluate and adapt care management programs based on the evolving needs of patient populations. Coordinate care activities with community partners, community-based organizations, and government-funded programs. Leverage value-based, population health data analytics to strengthen care coordination, complex case management, transitions of care, and new program development based on patient risk profiles. Oversee population health coordinator functions, including building a framework to identify and close care gaps using data analytics. Monitor key care management performance indicators, including patient caseloads, engagement, graduation rates, and other process measures. Oversee the community partner program manager and ensure compliance with ACO contract requirements. Apply a health equity lens to the design of population health initiatives, including data collection and recommendations that address disparities and remove member barriers to care. Ensure special initiatives such as SDOH programs, flexible benefits, and care needs screening are fully integrated into the care management workflow. What You'll Bring Current Registered Nurse (RN) licensure in the Commonwealth of Massachusetts. RN, BSN required; an advanced degree in a related field (business or clinical) is highly desirable. Certified Case Manager (CCM) credential highly desirable. Five or more years of clinical experience in a related field. Five or more years of management experience. A minimum of five years of managed care experience supervising care management teams. Working knowledge of performance dashboards and analytic functions. Demonstrated experience overseeing care management functions and working within value-based contracts. Proven collaborative leadership, including complex problem solving, stakeholder management, critical thinking, and conflict resolution. Ability to lead multidisciplinary teams and manage high-impact initiatives through cross-functional improvement teams. Strong communication skills, including the ability to engage teams in problem solving and drive key outcomes. Experience in regulated practice environments, including interpreting regulations and auditing operational performance (documentation, policy adherence, etc.). A confident, autonomous leader with strong interpersonal skills and a proven ability to thrive in a matrixed model where stakeholder engagement is essential. Strong organizational skills with the ability to prioritize and multitask. Working knowledge of Excel, PowerPoint, and Visio. Demonstrated experience working with diverse patient populations and a diverse workforce. Why Join Us This is more than a leadership role. It's a chance to build care models that close gaps, reduce disparities, and improve lives across the communities that need it most. If you are driven by purpose and ready to lead population health into its next chapter, we'd love to hear from you.