Provider Network National ACO Lead for Value-Based Contracting

Cinqcare • New York, NY

14h • Onsite

About The Position

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care. The National Network ACO Lead is a senior leader with financial and strategic acumen responsible for building, managing, and optimizing a high-performing ACO Provider Network that drives shared savings, risk adjustment accuracy, and total-cost-of-care reduction. This role combines deep value-based payment expertise with financial modeling and performance management to recruit financially sophisticated providers, negotiate risk-capable contracts, and deliver measurable ROI. The Lead serves as the primary financial and contract liaison to ACO providers, ensuring alignment of incentives, accurate attribution forecasting, and sustained profitability for both the ACO and its participants.

Requirements

• Bachelor’s degree in finance, Business, Healthcare Administration, or related field; MBA, MHA, or CPA strongly preferred.
• 7–10+ years of progressive experience in value-based care network development and financial performance management, with direct ACO, MSSP, or Medicare Advantage experience required.
• Advanced knowledge of CMS payment methodologies: prospective assignment, risk adjustment (HCC), shared savings calculations, quality withhold, and risk corridors.
• Proven track record negotiating risk-based and capitated contracts that delivered positive shared savings.
• Expert-level financial modeling skills (Excel, SQL, or BI tools) with ability to build provider-level P&L forecasts.
• Deep understanding of site-of-service economics, bundled payments, and ancillary cost drivers.
• Exceptional executive presence and ability to translate complex financial concepts into compelling provider value propositions.

Nice To Haves

• Experience with actuarial pricing, stop-loss reinsurance, or population health analytics.

Responsibilities

• Develop and execute a financially driven ACO network strategy that maximizes benchmark performance, shared savings potential, and risk adjustment factor (RAF) uplift.
• Perform attribution forecasting and financial pro forma modeling for prospective providers using CMS methodologies with actuarial support.
• Build and maintain advanced financial models to estimate provider-level shared savings, risk corridor exposure, and stop-loss requirements under Global and Professional capitation options for providers that opt for a capitation model.
• Partner with actuarial and finance teams to set provider-specific cost and quality targets that achieve ≥5% gross savings to benchmark.
• Lead negotiation of ACO participation agreements, including Preferred Provider addendums, shared savings distribution methodologies, risk-sharing arrangements, and performance-based withhold/recoupment clauses.
• Design and implement tiered reimbursement structures (e.g., enhanced FFS + care management fees + shared savings bonuses) that incentivize ambulatory shift and HRSN referral volume.
• Negotiate bundled and episodic payment arrangements with ancillary providers (ASCs, imaging centers, labs, DME) to reduce total cost of care by 20–40% versus hospital-based settings.
• Target and recruit high-ROI providers using financial opportunity analyses (e.g., “Your practice can gain $450K in additional shared savings +increments to Benchmark).
• Deliver executive-level presentations demonstrating provider-specific financial upside under ACO (benchmark comparison, attribution impact, quality payout scenarios).
• Oversee financial onboarding, including baseline cost analysis.
• Serve as the primary financial relationship manager for ACO providers, participate in select partnership reviews that tie clinical performance to dollars (shared savings forecasts, quality payout impact, leakage reports).
• Collaborate with data analytics to contribute to the design of provider-facing dashboards showing real-time financial performance (PMPM trends, HCC gap closure value, ancillary shift savings) and potentially forecasting shared savings performance.
• Drive corrective action plans for underperforming providers using financial levers (withhold recovery, tier demotion, enhanced support).

Benefits

• Medical Plans: Two comprehensive options offered to Team members.
• 401K: 4% employer match for your future.
• Dental & Vision: Flexible plans with in-network savings.
• Paid Time Off: Generous PTO, holidays, and wellness time.
• Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company-provided phones for field staff.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level