Senior Vice President, Value-Based Care - Population Health, Risk & Quality

Core Accountabilities

The Senior Vice President, Value-Based Care is 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.

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
• 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

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