Apply on Employer Site

CINQCARE · 1 week ago

Provider Network National ACO Lead for Value-Based Contracting

New York, NY

Full-time

Onsite

Senior Level

$150K/yr - $175K/yr

7+ years exp

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. The National Network ACO Lead is responsible for building, managing, and optimizing a high-performing ACO Provider Network, focusing on value-based payment expertise and financial performance management to drive shared savings and profitability.

CommunitiesHealth CareHome Health CareMedical

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)

Qualification

Value-based care expertiseFinancial modeling skillsNegotiation of contractsProvider recruitmentCMS payment methodologiesSite-of-service economicsPopulation health analyticsExecutive presenceCommunication skills

Required

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