VP, VBC Operations

Who we are…

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 role…

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.

Key Responsibilities

• 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

Qualifications

Experience

• 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

Skills & Attributes

• 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.

Background

• 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

Our Values

We are an Equal Opportunity E