Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is seeking a Principal Value-Based Care Operations Advisor to lead enterprise efforts supporting the design, operationalization, and optimization of value-based care programs. The role provides subject matter expertise across program design, contract execution, performance measurement, operational workflows, and financial reconciliation while aligning clinical, network, finance, actuarial, analytics, and operational stakeholders.
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
- 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
- In lieu of degree: 10+ years of directly related healthcare experience
- Experience operationalizing Medicare Advantage and Commercial VBC programs
- Experience supporting shared savings reconciliation or financial settlement processes
- Familiarity with attribution methodologies, performance measurement frameworks, and population health analytics
- Experience working within payer organizations or integrated delivery systems
- Consulting or enterprise transformation experience supporting healthcare operating model design
Benefits
- Annual Incentive Bonus, based on annual corporate goal achievement and individual performance
- 401(k) with employer match
- Paid Time Off (PTO)
- Competitive health benefits
- Wellness programs
- Hybrid work arrangement
Company Overview
Company H1B Sponsorship