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Duly Health and Care · 4 days ago

Vice President, VBC Payer Operations & Strategy

Downers Grove, IL

Full-time

Hybrid

Director/Executive

$171K/yr - $256K/yr

10+ years exp

Duly Health and Care is seeking a Vice President of Value-Based Care Payer Operations and Strategy to lead their value-based care programs and payer partnerships. The role involves overseeing payer relations, ensuring operational excellence, and driving strategic initiatives to enhance member growth and performance.

Health CarePersonal HealthWellness

Responsibilities

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 stregnthen 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

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

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

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

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

Support initiatives to enhance member engagement, retention, and satisfaction

Qualification

Healthcare operationsPayer contractingValue-based care programsMedicare AdvantageAnalytical mindsetLeadership skillsStrategic thinkerNegotiation skillsOperational excellenceRelationship managementCollaborative leadership

Required

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

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

Preferred

Master's in business administration, Healthcare Administration, or related field preferred

Benefits

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.