Executive Director, VBC Financial Operations

CVS Health•Hartford, CT

5d•$131,500 - $303,195

About The Position

The Executive Director, Value-Based Care Financial Operations leads financial operations, reconciliation, accrual governance, provider economics, and payment administration for Aetna’s value-based care portfolio across Medicare, Commercial, Specialty, and emerging risk-based arrangements. The role is the primary business owner for value-based care financial performance management, overseeing accurate provider performance reporting, contractual settlements, incentive payments, accruals, reconciliations, and financial forecasting. It partners with Finance, Medicare, Network, Value-Based Solutions, Actuarial, Operations, and Technology leaders to turn complex arrangements into scalable financial and operational processes that support business decisions. The Executive Director also owns critical attribution governance and provider alignment methodologies that support financial accuracy, consistent reporting, and contract performance measurement. The position provides strategic advice to senior leaders, influences decisions involving provider reimbursement and value-based strategy, and develops leadership talent and organizational capability across financial operations, reporting, and provider economics.

Requirements

15+ years of progressive leadership experience in healthcare finance, provider economics, value-based care, managed care, actuarial support, healthcare analytics, financial planning, or related disciplines.
5+ years leading managers and high-performing professional teams.
Demonstrated experience leading financial reporting, accrual management, forecasting, reconciliation, and performance measurement functions.
Deep understanding of Medicare Advantage financial drivers, provider reimbursement and incentive methodologies, risk adjustment programs, and value-based payment models.
Proven success leading large-scale cross-functional initiatives involving Finance, Operations, Network, Actuarial, Analytics, and Technology stakeholders.
Experience influencing executive decision-making through complex financial and operational analyses.
Demonstrated success designing scalable processes, operating models, and governance structures.
Experience supporting audit, compliance, and financial control environments.
Bachelor’s degree in Finance, Accounting, Economics, Business Administration, Healthcare Administration, Analytics, Actuarial Science, or a related field.

Nice To Haves

8+ years leading managers and high-performing professional teams.
Experience supporting multiple lines of business, including Medicare, Commercial, and Specialty value-based arrangements.
Master’s degree (MBA, MHA, MPH, or equivalent).
CPA, CFA, FSA, or related professional designation.

Responsibilities

Lead enterprise value-based care financial reporting, accruals, forecasting, reconciliation, and performance measurement.
Establish methodologies for provider settlements, shared savings arrangements, quality incentives, capitation models, and specialty value-based contracts.
Partner with Finance and Actuarial leadership to ensure financial reporting accurately reflects contractual obligations, emerging trends, and business risks.
Provide executive leadership with insights into financial drivers, trends, opportunities, and material variances.
Own governance and execution of monthly and annual value-based care accrual processes, including recurring reviews with Finance, Medicare leadership, provider contracting teams, and market leadership.
Ensure compliance with financial controls, audit requirements, and governance standards; maintain accountability for methodologies supporting liabilities, receivables, and provider settlements.
Serve as senior escalation point for financial reporting issues affecting providers, business partners, or enterprise financial performance.
Provide executive oversight of value-based care payment operations, provider settlements, incentive administration, and reconciliation workflows.
Partner with Controllers, Treasury, Finance, and Operations to strengthen controls and improve processes; drive automation and simplification to reduce administrative burden and improve accuracy.
Collaborate with Network and Value-Based Solutions leaders to ensure operational and financial readiness for new payment models and contractual structures.
Lead evaluation of financial impacts associated with risk adjustment programs, revenue integrity activities, final sweeps, audits, and Medicare revenue processes.
Direct analyses of financial drivers affecting provider settlements and enterprise performance, and communicate emerging risks, opportunities, and exposures to executive leadership.
Establish governance and communication processes for material provider-facing financial impacts.
Own attribution governance supporting provider performance measurement and financial reporting; establish standards for attribution methodologies, provider hierarchy definitions, business rules, and reporting alignment.
Ensure attribution processes are transparent, auditable, and financially accurate across value-based programs; partner with business and technology teams on enhancements.
Advise senior leaders across Finance, Network, Medicare, Commercial, Medicaid, Specialty, Operations, and Technology organizations.
Influence enterprise decisions concerning provider reimbursement, value-based strategy, financial risk, and operational scalability.
Develop leadership talent and organizational capability across financial operations, reporting, and provider economics functions.