Pearl Health is powering the future of healthcare. We help primary care providers and organizations to deliver quality healthcare to the patients who need it most, when they need it most — and get rewarded for keeping patients healthy.
Our technology, services, and financial tools enable better, more proactive care, decrease total cost of care across patient panels, and optimize performance in value-based care models for Traditional Medicare and Medicare Advantage.
We are a team of physicians and public health experts (Stanford, Harvard, Mount Sinai), technologists (athenahealth, Amazon, Meta, Flatiron), healthcare innovators (Centivo, Aledade, Stellar, Arcadia), and experienced risk management professionals (CVS/Aetna, Humana, Oscar) who believe that primary care providers are the key to addressing our healthcare system’s biggest challenges.
Since its founding in 2020, Pearl has expanded to partner with thousands of primary care providers in practices and organizations across 44 states. Our investors include Andreessen Horowitz, Viking Global Investors, AlleyCorp, and SV Angel.
The VP, VBC Operations will lead Pearl Health's efforts to ensure Medicare patients managed by our practice partners have appropriate benchmarks based on their condition. This critical role focuses on creating systems, developing vendor and internal capabilities, and strengthening client partnerships. The ideal candidate will enable the generation of savings against fair benchmarks while maintaining clinical integrity and regulatory compliance.
The role will report directly to the Chief Operating & Compliance Officer.
Improve upon and excellently execute a comprehensive benchmark accuracy strategy for Traditional Medicare
Create scalable, compliant processes that can adapt to changing regulations and practice needs
Build programs that equip providers with actionable insights to improve diagnosis accuracy
Partner with Pearl’s Customer Success team to drive provider engagement in benchmark accuracy initiatives through education and support
Translate complex risk adjustment concepts into actionable guidance for clinical teams
Partner with R&D, Finance, Actuarial, Data Science & Analytics and Customer Success teams on data-driven strategic prioritization and partner selection
Coordinate with external vendors to enhance capabilities and fill strategic gaps
Identify and implement technology solutions that aggregate claims, encounter, and clinical data
Drive proactive condition identification through advanced analytics
Ensure all activities adhere to CMS guidelines and documentation requirements
Stay ahead of policy changes and adapt strategies accordingly
7+ years of experience in healthcare operations, with significant focus on value-based care or risk adjustment initiatives a plus
Proven track record of developing and scaling benchmark accuracy or risk adjustment programs
Experience engaging with providers and health system leaders on clinical documentation improvement
Deep understanding of regulatory and compliance requirements relevant to the above domains
Demonstrable success in Traditional Medicare value-based models (MSSP, GPDC, ACO REACH, etc.); comparable experience in Medicare Advantage programs a plus
Exceptional operational leadership with attention to detail and process excellence
Strong understanding of CMS risk adjustment methodologies and regulatory requirements, or demonstrated experience with comparable subject matter and ability to ramp rapidly
Ability to translate complex data into actionable insights for clinical teams
Outstanding communication skills at all levels of an organization
Data-driven decision making with a focus on measurable outcomes
Strategic thinking balanced with a bias towards execution
Strong organizational skills and detail-orientation.
Capability of effectively handling multiple priorities in a fast-paced environment as part of a lean team.
Bachelor's degree or equivalent required; Master's degree in healthcare administration, business, public health, or related field preferred
Clinical background or certification in risk adjustment, coding, or healthcare compliance is a nice-to-have
We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Our definition of diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. We believe all of our colleagues’ points of view are integral to our success, and that inclusion is everyone's responsibility and a cause of beautiful things.
We welcome candidates from all backgrounds and are committed to a fair hiring process free from discrimination and focused around problem solving, improvement, and mutual empowerment.
If a resume is submitted to any Pearl Health employee by a third party without a valid written and signed search agreement, it will become the property of Pearl Health and no fee will be paid, irrespective of whether the candidate is hired.
The salary range Pearl Health expects to pay for this position is between $175,000 and $225,000 per year. Full time employees are also eligible for annual discretionary bonus and equity options. Where a given candidate falls within the compensation range will depend on a variety of factors, including, but not limited to, the candidate’s relevant skills, experience and location, labor market conditions and participation, if any, in other compensation arrangements.
Remote candidates will be considered. Candidates based in the New York City area may be given preference.
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Are you ready to take your healthcare operations leadership to the next level? Pearl Health is on the lookout for a dynamic VP, VBC Operations to join our team in New York City. At Pearl Health, we're dedicated to revolutionizing healthcare for Medicare patients by ensuring our primary care providers deliver top-notch services when it's needed most. As the VP, VBC Operations, you'll play a pivotal role in developing comprehensive strategies for benchmark accuracy in Traditional Medicare, enhancing clinical integrity while adhering to regulatory compliance. Your expertise will guide us in creating scalable processes that respond proactively to changing regulations and evolving practice needs, all aimed at improving patient outcomes. You'll collaborate with multiple teams, translating complex risk adjustment concepts into actionable insights that empower providers. Plus, with your skills in strategic prioritization and data-driven decision-making, you’ll help identify technology solutions that aggregate essential data. If you have over 7 years of healthcare operations experience, particularly in risk adjustment initiatives, and possess exceptional communication and organizational skills, we want to hear from you. Join us in our mission to empower primary care providers and reshape the future of healthcare!
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