The Senior Vice President, Value-Based Care is an enterprise executive accountable for end-to-end performance across population health, risk adjustment, quality and medical expense (affordability). This role integrates strategy and execution to deliver superior clinical outcomes, revenue integrity and total cost of care performance across all markets and lines of business.
The Senior Vice President leads a comprehensive value-based care operating model spanning risk capture, quality performance, utilization management, network optimization and cost management, ensuring aligned execution across clinical, operational, financial and analytic functions. This leader drives measurable improvement in affordability, provider performance and member outcomes through scaled operating rigor, standardized processes and market accountability.
Core Accountabilities (What Success Looks Like)- Deliver Performance: Achieve sustained improvement in total cost of care, risk score accuracy and quality outcomes across markets
- Integrate Value-Based Model: Align risk, quality and medical expense strategies into a unified, enterprise operating framework
- Drive Affordability: Reduce unnecessary utilization, cost leakage and variation while improving care coordination and outcomes
- Ensure Compliance & Integrity: Maintain audit-ready, compliant operations across risk adjustment, coding and quality programs
- Scale Execution: Standardize processes and enable consistent, high-performing execution across markets and provider networks
- Lead Enterprise Influence: Align executive stakeholders across clinical, finance, actuarial, operations and analytics to achieve shared outcomes
Primary Responsibilities:Enterprise Value-Based Care Strategy & Governance- Define and lead the enterprise strategy for population health, risk adjustment, quality and affordability
- Translate strategy into operating plans, KPIs and performance targets across regions and markets
- Establish a rigorous operating cadence (performance reviews, deep dives, escalation pathways) to drive accountability and results
- Ensure alignment between enterprise priorities and market execution, balancing standardization with local flexibility
Risk Adjustment & Revenue Integrity- Own enterprise strategy and execution for risk adjustment programs, ensuring complete, accurate and compliant risk capture
- Oversee prospective, concurrent and retrospective workflows, enabling provider adoption and documentation excellence
- Ensure solid controls, submission accuracy and audit readiness across all risk activities
- Partner with finance and actuarial teams to manage forecasting, accruals and revenue validation
Quality Performance & Clinical Outcomes- Lead enterprise quality strategy and performance improvement aligned to payer and regulatory programs (e.g., Stars, HEDIS, CAHPS)
- Drive measure closure, clinical gap closure and patient experience outcomes across markets
- Establish consistent quality governance, reporting and intervention frameworks to improve reliability and reduce variation
Medical Expense (MedEx) & Total Cost of Care Performance- Drive enterprise performance across medical expense, utilization and affordability metrics
- Lead initiatives to optimize:
- Inpatient utilization (bed days, length of stay, readmissions)
- Emergency and avoidable utilization
- Post-acute, specialty and site-of-care optimization
- Reduce cost leakage through improved referral management, network alignment and utilization controls
- Deliver measurable ROI and sustained cost reduction across markets
Network & Provider Performance Optimization- Partner with network, clinical and operations leaders to optimize provider performance and engagement
- Improve in-network utilization, access and care coordination
- Identify and address capacity constraints, referral patterns and performance gaps
Analytics, Insights & Performance Management- Establish enterprise dashboards and KPIs to monitor risk, quality, utilization and cost performance
- Translate data into actionable insights, prioritized interventions and measurable outcomes
- Partner with analytics teams to improve targeting, forecasting and performance transparency
Operational Excellence & Standardization- Develop and scale standard operating models, workflows and best practices across markets
- Lead continuous improvement initiatives to reduce variation and improve reliability
- Enable technology adoption and process optimization at scale
Compliance, Controls & Audit Readiness- Ensure adherence to regulatory requirements, coding standards and quality program guidelines
- Maintain audit-ready environments (e.g., RADV, OIG) and lead response/remediation efforts
- Implement solid controls, policies and monitoring frameworks to mitigate risk
Leadership & Talent Development- Build and lead high-performing, enterprise-scale teams across value-based care, risk, quality and affordability
- Develop leadership bench strength, succession plans and critical capabilities
- Influence and align cross-functional executive stakeholders to deliver enterprise outcomes
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 15+ years healthcare experience with significant executive leadership responsibility
- 10+ years of deep expertise in value-based care, population health, risk adjustment and medical expense management
- Demonstrated success delivering risk, quality and cost-of-care performance at scale in complex, matrixed organizations
- Solid financial, analytical and operational acumen, including forecasting, KPI management and performance optimization
Preferred Qualifications:- Experience with Medicare Advantage, risk-bearing entities or large physician networks
- Expertise in Stars, HEDIS, CAHPS and regulatory/audit environments
- Proven ability to standardize and scale operating models across markets
- Advanced capabilities in analytics-driven performance management and transformation leadership
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $200,400 to $343,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.
