Executive Director, VBC Financial Operations

CVS Health; Hartford (CT); Presencial; USD 132.000 - 303.000; Jornada completa

Descripción de la vacante

CVS Health is seeking an Executive Director, Value-Based Care Financial Operations to lead financial performance, accrual governance, and payment administration across Medicare, Commercial and Specialty VB arrangements.

You will partner with Finance, Actuarial, Network, VBS and Operations to translate complex value-based contracts into scalable financial processes, reporting, and controls, ensuring accurate provider settlements and performance analysis.

Formación

• 15+ years of progressive leadership experience in healthcare finance, provider economics, value-based care, or related fields.
• 5+ years leading managers and high-performing professional teams; 8+ years preferred.
• Experience leading financial reporting, accruals, forecasting, reconciliation, and performance measurement.
• Deep understanding of Medicare Advantage financial drivers, provider reimbursement and incentive methodologies, risk adjustment programs, and value-based payment models.
• Experience supporting multiple lines of business, including Medicare, Commercial and Specialty VB arrangements.

Responsabilidades

• Lead enterprise VBC financial reporting, accruals, forecasting, reconciliation, and performance measurement.
• Establish methodologies supporting provider settlements, shared savings arrangements, quality incentives, capitation models, and specialty value-based contracts.
• Partner with Finance and Actuarial leadership to ensure financial reporting reflects obligations, trends, and risks.
• Own governance and execution of monthly and annual VBC accrual processes; lead reviews with Finance and leadership.
• Maintain controls and governance standards; serve as escalation point for financial reporting issues.
• Lead attribution governance for provider performance measurement and reporting; ensure auditable processes.

Conocimientos

Leadership experience

Financial analysis

Stakeholder influence

Healthcare finance knowledge

Educación

Bachelor's degree

Master's degree preferred

CPA/CFA preferred

Descripción del empleo

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Executive Director, Value-Based Care Financial Operations is responsible for leading the financial operations, reconciliation, accrual governance, provider economics, and payment administration functions that support Aetna's value-based care portfolio across Medicare, Commercial, Specialty, and emerging risk-based arrangements.

This leader serves as the primary business owner for VBC financial performance management, ensuring accurate reporting of provider performance, contractual settlements, incentive payments, accruals, reconciliations, and financial forecasting. The role partners closely with Finance, Medicare, Network, Value-Based Solutions (VBS), Actuarial, Operations, and Technology leaders to translate complex value-based arrangements into scalable financial and operational processes that support business decision-making.

In addition to financial leadership responsibilities, the Executive Director maintains business ownership of critical attribution governance and provider alignment methodologies that support financial accuracy, reporting consistency, and contract performance measurement across value-based care programs.

Major Responsibilities

1. Financial Performance Management & Reporting

• Lead enterprise VBC financial reporting, accruals, forecasting, reconciliation, and performance measurement activities.
• Establish methodologies supporting provider settlements, shared savings arrangements, quality incentives, capitation models, and specialty value-based contracts.
• Partner with Finance and Actuarial leadership to ensure financial reporting accurately reflects contractual obligations, emerging trends, and business risks.
• Provide executive leadership with insight into financial drivers, trends, opportunities, and material variances.

2. Accrual Governance & Financial Controls

• Own governance and execution of monthly and annual VBC accrual processes.
• Lead recurring accrual reviews involving Finance, Medicare leadership, provider contracting teams, and market leadership.
• Ensure compliance with established financial controls, audit requirements, and governance standards.
• Maintain accountability for methodologies supporting liabilities, receivables, and provider settlements.
• Serve as senior escalation point for financial reporting issues impacting providers, business partners, or enterprise financial performance.

3. Payment Operations & Reconciliation Leadership

• Provide executive oversight of VBC payment operations, provider settlements, incentive administration, and reconciliation workflows.
• Ensure payment operations are scalable, compliant, and operationally efficient.
• Partner with Controllers, Treasury, Finance, and Operations teams to strengthen controls and improve processes.
• Drive automation and simplification efforts that reduce administrative burden while improving financial accuracy.
• Collaborate with Network and VBS leaders to ensure operational and financial readiness for new payment models and contractual structures.

4. Risk Adjustment, Revenue Integrity & Financial Impact Analysis

• Lead evaluation of financial impacts associated with risk adjustment programs, revenue integrity activities, final sweeps, audits, and Medicare revenue processes.
• Direct analyses of key financial drivers impacting provider settlements and enterprise financial performance.
• Communicate emerging risks, opportunities, and financial exposures to executive leadership.
• Establish governance and communication processes for material provider-facing financial impacts.

5. Attribution Governance & Business Ownership

• Serve as business owner for attribution governance supporting provider performance measurement and financial reporting.
• Establish standards for attribution methodologies, provider hierarchy definitions, business rules, and reporting alignment.
• Ensure attribution processes remain transparent, auditable, and financially accurate across all value-based programs.
• Partner with business and technology teams to support enhancements while maintaining focus on operational and financial outcomes.

6. Strategic Leadership & Business Partnership

• Serve as a strategic advisor to senior leaders across Finance, Network, Medicare, Commercial, Medicaid, Specialty, Operations, and Technology organizations.
• Influence enterprise decisions involving provider reimbursement, value-based strategy, financial risk, and operational scalability.
• Develop leadership talent and organizational capability across financial operations, reporting, and provider economics functions.

Required Qualifications

• 15+ years of progressive leadership experience in healthcare finance, provider economics, value-based care, managed care, actuarial support, healthcare analytics, financial planning, or related disciplines required.
• 5+ years leading managers and high-performing professional teams required, 8+ years preferred.
• Demonstrated experience leading financial reporting, accrual management, forecasting, reconciliation, and performance measurement functions.
• Deep understanding of Medicare Advantage financial drivers, provider reimbursement and incentive methodologies, risk adjustment programs, and value-based payment models.
• Experience supporting multiple lines of business, including Medicare, Commercial and Specialty value-based arrangements, preferred.
• Proven success leading large-scale, cross-functional initiatives involving Finance, Operations, Network, Actuarial, Analytics, and Technology stakeholders.
• Experience influencing executive decision-making through complex financial and operational analyses.
• Demonstrated success designing scalable processes, operating models, and governance structures.
• Experience supporting audit, compliance, and financial control environments.

Education

Bachelor's degree in Finance, Accounting, Economics, Business Administration, Healthcare Administration, Analytics, Actuarial Science, or a related field required.

Master's degree (MBA, MHA, MPH, or equivalent) preferred.

CPA, CFA, FSA, or related professional designation preferred.

Pay Range

The typical pay range for this role is:

$131,500.00 - $303,195.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 11/16/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.