Vice President, VBC Payer Operations & Strategy

Overview

Employment Type: Full-time (40 hours/week)

Schedule: Monday–Friday, standard business hours

Work Arrangement: Hybrid

Location: Downers Grove, IL

• Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance.
• Access to a mental health benefit at no cost.
• Employer provided life and disability insurance.
• $5,250 Tuition Reimbursement per year.
• Immediate 401(k) match.
• A culture committed to community engagement and social impact.
• Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.

Employment Type: Full-time (40 hours/week)

Schedule: Monday–Friday, standard business hours

Work Arrangement: Hybrid

Location: Downers Grove, IL

• Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance.
• Access to a mental health benefit at no cost.
• Employer provided life and disability insurance.
• $5,250 Tuition Reimbursement per year.
• Immediate 401(k) match.
• 40 hours paid volunteer time off.
• A culture committed to community engagement and social impact.
• Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.

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.

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.

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…