Senior Value-Based Care Operations Leader

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

Job summary

Blue Cross NC seeks a Principal Value-Based Care Operations Advisor to lead design, execution, and optimization of value-based care programs across the full operational lifecycle. You will partner across clinical, finance, actuarial, analytics, and network teams to translate objectives into scalable operating models and measurable outcomes.

The role requires 8+ years in healthcare operations or consulting, strong reimbursement and performance measurement understanding, and leadership experience

Qualifications

• Bachelor's or advanced degree required; healthcare admin, business, public health or related field.
• 8+ years in healthcare operations, value-based care programs, payer-provider strategy or healthcare consulting.
• Experience supporting or operating value-based care models including total cost of care or risk-based arrangements.

Responsibilities

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

Skills

Healthcare Operations

Healthcare Process Improvement

Healthcare Reimbursement

Operational Efficiency

Operational Process Improvements

People Management

Project Management

Provider Reimbursement

Reporting and Analysis

Strategic Planning

Education

Bachelor's degree or advanced degree in healthcare administration, business, public health, or related field

Job description

Blue Cross NC seeks a Principal Value-Based Care Operations Advisor to lead design, execution, and optimization of value-based care programs across the full operational lifecycle. You will partner across clinical, finance, actuarial, analytics, and network teams to translate objectives into scalable operating models and measurable outcomes.

The role requires 8+ years in healthcare operations or consulting, strong reimbursement and performance measurement understanding, and leadership experience