Value-Based Care Operations Leader

Blue Cross and Blue Shield of North Carolina; Michigan; Hybrid; USD 131,000 - 209,000; Full time

Job summary

Blue Cross NC seeks a Principal Value-Based Care Operations Advisor to lead enterprise initiatives designing and optimizing value-based care programs across the full lifecycle. This role partners across clinical, finance, actuarial, analytics, and network teams to translate strategic objectives into scalable operating models and drive measurable outcomes.

The candidate will mentor teams, present insights to senior leadership, and help implement reimbursement models and provider strategies with

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 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.

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 higher in healthcare administration or related field

10+ years healthcare experience in lieu of degree

Job description

Blue Cross NC seeks a Principal Value-Based Care Operations Advisor to lead enterprise initiatives designing and optimizing value-based care programs across the full lifecycle. This role partners across clinical, finance, actuarial, analytics, and network teams to translate strategic objectives into scalable operating models and drive measurable outcomes.

The candidate will mentor teams, present insights to senior leadership, and help implement reimbursement models and provider strategies with