Value-Based Care Operations Leader & Architect

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

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Principal Value-Based Care Operations Advisor to lead design, execution, and optimization of value-based care programs across the full lifecycle.

You will partner with clinical, finance, actuarial, analytics, and network teams to translate objectives into scalable operating models and measurable outcomes, ensuring operational readiness and sustainable performance.

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.
• 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 align program design with execution.
• Support development and refinement of VBC operating models and cross-functional processes.
• Evaluate program performance drivers and recommend operational improvements for outcomes and sustainability.
• Provide expertise supporting implementation of new reimbursement models and provider partnership strategies.
• Lead 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 to support scalability and measurement integrity.
• Identify risks to program execution and develop mitigation strategies across domains.
• Present insights and strategic recommendations to senior leadership.
• Serve as SME for value-based care operations and enterprise transformation initiatives.
• Mentor and guide team members supporting value-based care program delivery.

Skills

Healthcare operations

Value-based care

Payer-provider strategy

Performance measurement

Leadership

Healthcare reimbursement

Project management

Education

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

In lieu of degree: 10+ years of healthcare experience

Job description

Blue Cross and Blue Shield of North Carolina is seeking a Principal Value-Based Care Operations Advisor to lead design, execution, and optimization of value-based care programs across the full lifecycle.

You will partner with clinical, finance, actuarial, analytics, and network teams to translate objectives into scalable operating models and measurable outcomes, ensuring operational readiness and sustainable performance.