Senior Value-Based Care Operations Architect

Blue Cross and Blue Shield of North Carolina; Idaho; On-site; USD 131,000 - 209,000; Full time

Job summary

Blue Cross NC in the United States seeks a Principal Value-Based Care Operations Advisor to lead design, operationalization, and optimization of value-based care programs across the full lifecycle. You will translate strategic objectives into scalable operating models and drive alignment among clinical, finance, analytics, and network teams.

The role demands 8+ years in healthcare operations or consulting and a strong grasp of reimbursement and performance metrics.

Qualifications

• Bachelor’s degree or advanced degree in healthcare administration, business, public health, or related field.
• 8+ years of experience in healthcare operations, value-based care programs, payer-provider strategy, or healthcare consulting.
• Demonstrated experience supporting or operating value-based care models including total cost of care or risk-based arrangements.
• Experience across clinical operations, finance, analytics, and network/provider engagement.
• Strong understanding of healthcare reimbursement and performance measurement concepts.

Responsibilities

• Lead end-to-end operational design of value-based care programs, including shared savings, downside risk, and alternative payment models.
• Translate strategic program objectives into operational workflows, governance structures, and execution plans.
• Identify operational gaps across contracting, attribution, performance measurement, reporting, and financial settlement processes.
• Partner with clinical, finance, actuarial, analytics, and network teams to ensure alignment between program design and operational execution.
• Support development and refinement of VBC operating models and cross-functional processes.
• Evaluate program performance drivers and recommend operational improvements to enhance outcomes and financial sustainability.
• Provide expertise supporting implementation of new reimbursement models and provider partnership strategies.
• Lead complex cross-functional initiatives requiring coordination across enterprise stakeholders and external partners.
• Support provider engagement strategies by ensuring operational readiness and clarity of performance expectations.
• Establish repeatable processes and controls supporting program scalability and measurement integrity.
• Identify risks to program execution and develop mitigation strategies across operational domains.
• Present operational insights, performance implications, and strategic recommendations to senior leadership.
• Serve as a subject matter expert for value-based care operations and enterprise transformation initiatives.
• Mentor and guide team members supporting value-based care program delivery.

Skills

Healthcare ops

Value-based care

Cost of care

Program design

Cross-functional collaboration

Performance measurement

Reimbursement concepts

Leadership

Education

Bachelor’s degree or higher

Job description

Blue Cross NC in the United States seeks a Principal Value-Based Care Operations Advisor to lead design, operationalization, and optimization of value-based care programs across the full lifecycle. You will translate strategic objectives into scalable operating models and drive alignment among clinical, finance, analytics, and network teams.

The role demands 8+ years in healthcare operations or consulting and a strong grasp of reimbursement and performance metrics.