VP of Value-Based Care Operations - Remote (US)

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Requirements:

• 5+ years of operational leadership experience in healthcare, with a strong emphasis on value-based care models, ACOs, or post-acute care.
• Demonstrated success in developing ACO partnerships and value-based care strategies.
• Deep understanding of CMS models (GUIDE, MSSP, Medicare Advantage, ACOs, and value-based reimbursement frameworks).
• Experience with provider engagement and care coordination workflows in post-acute or transitional care settings.

Responsibilities:

• Lead the operational execution of Theoria Medical’s value-based care strategy, ensuring alignment with CMS GUIDE Model, ACOs, Medicare Advantage, and other VBC frameworks.
• Oversee key initiatives, including risk stratification, care coordination workflows, and provider engagement strategies to drive improved patient outcomes and financial performance.
• Develop and manage operational performance metrics, identifying areas for process improvement, cost reduction, and quality enhancement.
• Optimize patient engagement strategies to increase adherence to value-based care programs and initiatives.
• Partner with the VP of Clinical Operations to ensure seamless execution of GUIDE Model requirements, including care navigation and respite service implementation.
• Lead cross-functional teams in data analytics, provider education, and operational efficiency efforts to enhance Theoria Medical’s position in VBC programs.
• Ensure compliance with CMS and payer requirements, tracking key performance indicators (KPIs) tied to reimbursement and quality benchmarks.
• Drive operational excellence in post-acute care coordination, managing provider workflows to reduce hospital readmissions and improve care transitions.
• Develop and execute strategies to integrate Theoria Medical’s services into value-based contracts with ACOs, Hospitals, Medicare Advantage plans, and payer networks.
• Identify and engage strategic partners to position Theoria Medical as a premier post-acute care provider.
• Monitor financial performance under risk-based contracts, working closely with finance and analytics teams to optimize shared savings and quality incentives.
• Serve as the operational lead in contract negotiations, data reporting, and VBC program implementation.
• Oversee the collection, analysis, and reporting of operational and financial data to measure the success of VBC initiatives.
• Utilize predictive analytics and technology solutions to enhance care delivery, streamline workflows, and improve provider efficiency.
• Develop operational best practices to enhance provider engagement, patient adherence, and overall quality performance within Theoria Medical’s VBC framework.