Value-Based Care Operations Architect

Blue Cross and Blue Shield of North Carolina; Virginia (IL); On-site; USD 131,000 - 209,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off (PTO)

Health benefits

Wellness programs

Job summary

Blue Cross NC is seeking a Principal Value-Based Care Operations Advisor to lead end-to-end operational design for value-based care programs and to translate objectives into scalable operating models. You will collaborate with clinical, finance, analytics, and network teams to ensure programs are executable, measurable, and sustainable.

The role requires 8+ years in healthcare operations or payer-provider strategy with deep knowledge of reimbursement, performance measurement, and cross-domain

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 working across multiple healthcare domains including 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 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

10+ years of directly related healthcare experience

Job description

Blue Cross NC is seeking a Principal Value-Based Care Operations Advisor to lead end-to-end operational design for value-based care programs and to translate objectives into scalable operating models. You will collaborate with clinical, finance, analytics, and network teams to ensure programs are executable, measurable, and sustainable.

The role requires 8+ years in healthcare operations or payer-provider strategy with deep knowledge of reimbursement, performance measurement, and cross-domain