Vice President, VBC Payer Operations & Strategy

Overview

Vice President, VBC Payer Operations & Strategy

• Full-Time, 40 hours per week.

• Monday - Friday;
Business hours.

• Location - Downers Grove, IL

The Vice President (VP) of Value-Based Care (VBC) Payer Operations and Strategy is responsible for leading the organization’s value-based care programs and payer partnerships across multiple lines of business, including Medicare Advantage (MA), ACO REACH, and MSSP. This executive leader will serve as the subject matter expert for VBC programs, drive operational excellence in program execution, and ensure success in partial risk arrangements.

The VP will oversee payer relations, utilization management, and strategic initiatives that drive member growth and overall performance.

Responsibilities

Program Expertise and Operations

• Serve as the organization’s subject matter expert on all value-based care programs, including Medicare Advantage, ACO REACH, and MSSP.

• Ensure all day-to-day program and compliance requirements are met across lines of business.

• Analyze, evaluate and advise on strategic program options, including expansion opportunities, model redesigns, and new value-based initiatives that strengthen financial and clinical performance.

• Partner with cross-functional teams (finance, clinical operations, analytics, compliance) to ensure system-level alignment, operational readiness and data-driven execution.

Success of Partial Risk Programs

• Oversee performance in partial and full-risk contracts, ensuring clinical and financial success.

• Develop and execute analytically driven strategies to improve quality, outcomes, and shared savings performance.

• Identify and mitigate risk drivers, ensuring contract and benchmark targets are achieved.

Payer Management and Relations

• Lead day-to-day payer relationship management, including performance reviews, issue resolution, and collaboration on care initiatives.

• Evaluate and negotiate new payer contracts through a data-informed, analytical framework that aligns with organizational strategy.

• Serve as a trusted integrator between internal teams and external payers to promote transparency, accountability, and partnership success.

Oversight of Utilization Management (UM)

• Provide executive oversight for the Utilization Management (UM) function, ensuring compliance, efficiency, and appropriate care utilization.

• Drive alignment between UM, care management, and quality improvement to achieve value-based outcomes.

• Ensure policies, workflows, and reporting are technically sound, data-driven, and compliant with payer and regulatory requirements.

Member and Strategic Growth

• Develop and implement strategies to grow membership within existing and new markets.

• Support initiatives to enhance member engagement, retention, and satisfaction.

Qualifications

EXPERIENCE MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES

• 10+ years of experience in healthcare operations, payer contracting, or value-based care programs.

• Deep understanding of Medicare Advantage, ACO REACH, and MSSP programs.

• Proven success managing payer relationships and executing risk-based contracts.

• Strong leadership skills with experience overseeing cross-functional teams, including UM and care management.

• Strategic thinker with ability to balance long-term vision with operational execution.

• Bachelor’s degree required; master’s in business administration, Healthcare Administration, or related field preferred.

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES

• Expertise in CMS programs and VBC performance metrics

• Strategic and analytical mindset

• Strong negotiation and relationship management skills

• Operational excellence and process improvement orientation

• Collaborative leadership style with executive presence

The compensation for this role includes a base pay range of $125,000-$188,000, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.

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