Senior Vice President, Value-Based Care Resume

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Senior Vice President, Value-Based Care Resume Lorenzo Jennings Senior Vice President, Value-Based Care (303) 555-0194 lorenzo.jennings@example.com lorenzojennings Denver, CO 80202 STRENGTHS Enterprise alignment Connected clinical, finance, actuarial, network, and analytics leaders around shared market goals and recurring accountability reviews. Data into action Built provider scorecards that brought risk, quality, utilization, and referral signals together so local leaders could target follow-up. Audit readiness Partnered with compliance and provider teams to organize evidence, tighten submission checks, and address findings before review. Care transitions Used inpatient and post-discharge case reviews with nursing and physician partners to surface handoff risks and guide timely follow-up. Market execution Translated enterprise priorities into local action plans, giving market teams clearer measures, owners, and escalation paths. SKILLS Value-Based Care Strategy Population Health Medicare Advantage Risk Adjustment Revenue Integrity Stars and HEDIS CAHPS Quality Programs Medical Expense Management Total Cost of Care Utilization Management Network Performance Care Coordination Referral Management Healthcare Forecasting Executive Governance MY CAREER 25.8 Years Executive Vice President, Value-Based Care at Cedar Ridge Health (4.6 Years) Chief Population Health Officer at WellSpring Physician Alliance (4.6 Years) Vice President, Risk Adjustment and Quality at Blue Mesa Health Plan (5.7 Years) Director, Population Health at Northstar Medical Group (5.6 Years) Senior Director, Care Management at MeridianCare Partners (5.4 Years) SUMMARY Healthcare executive with 25+ years advancing care delivery, population health , and financial performance, including more than 20 years in value-based care. Lead Medicare Advantage , physician network, and health plan initiatives spanning risk adjustment, quality, and medical expense management . Translate enterprise priorities into market operating plans , shared KPIs, and accountable leadership routines, aligning clinical, finance, actuarial, network, and analytics partners. Direct risk capture, provider documentation, quality improvement, utilization, and affordability programs, with attention to revenue validation, audit readiness, and member outcomes. Across 12 markets, introduced executive reviews connecting Stars, HEDIS, CAHPS, risk, utilization, and cost measures to local actions and escalation paths. Hold a Master of Health Administration and bring executive experience in forecasting, provider engagement, and performance analytics. EXPERIENCE Executive Vice President, Value-Based Care Cedar Ridge Health Apr 2022 - Present Denver, CO Leads value-based care performance across 12 markets, aligning clinical, finance, actuarial, network, and analytics leaders around shared risk, quality, and affordability priorities. Introduced a quarterly operating review linking Stars, HEDIS, CAHPS, risk capture, utilization, and medical expense measures to market action plans and executive escalation paths. Strengthened Medicare Advantage documentation and submission controls through provider education, pre-submission validation, and audit preparation, improving revenue confidence and RADV readiness. Directed a cross-market affordability portfolio focused on inpatient days, avoidable emergency use, post-acute transitions, and specialty referrals, with ROI tracked through finance-validated dashboards. Established enterprise performance management with market operating plans and KPI management , pairing risk, quality, utilization, and cost forecasts with named owners and quarterly intervention reviews. Standardized prospective, concurrent, and retrospective risk adjustment workflows , adding coding standards, provider documentation adoption checks, and revenue validation controls to strengthen revenue integrity and RADV and OIG audit readiness. Aligned senior stakeholders on total cost of care priorities through cross-functional leadership , setting measurable clinical outcomes and patient experience targets alongside affordability goals. Chief Population Health Officer WellSpring Physician Alliance Sep 2017 - Mar 2022 Boulder, CO Led population health strategy for a multi-state physician organization, bringing primary care, care management, quality, and network teams into a shared value-based operating structure. Built provider scorecards that paired risk documentation and quality gaps with utilization and referral patterns, helping medical group leaders prioritize practice-level interventions. Expanded care coordination for high-risk Medicare Advantage members through post-discharge outreach and primary care follow-up, reducing avoidable handoff failures. Partnered with actuarial and finance leaders on contract forecasts and performance reviews, improving the visibility of shared-savings and medical expense drivers. Introduced multi-market operating models for risk-bearing organizations , standardizing provider scorecards and practice-level action reviews to reduce reporting variation across states. Worked with network and clinical leaders on referral management , identifying capacity gaps and avoidable out-of-network use, then routing members to available in-network specialty care. Vice President, Risk Adjustment and Quality Blue Mesa Health Plan Jan 2012 - Aug 2017 Phoenix, AZ Directed risk adjustment and quality operations for Medicare Advantage products, coordinating coding, provider documentation, measure performance, and compliance across regional teams. Reworked prospective and retrospective chart review workflows with clinical and coding leaders, improving documentation completeness and strengthening submission validation. Established a common Stars , HEDIS , and CAHPS review process that helped market teams focus on measure gaps, member experience issues, and intervention follow-through. Coordinated audit evidence and remediation across compliance, operations, and provider partners, making program controls more consistent and review-ready. Added analytics-driven performance management to monthly quality reviews, using market-level care-gap closure and submission trends to direct targeted provider follow-up and improve measure consistency. Coordinated audit remediation with compliance and coding teams, mapping supporting records to submission controls and preparing organized evidence for regulatory review. Director, Population Health Northstar Medical Group Jun 2006 - Dec 2011 Portland, OR Developed population health operations for a growing physician network participating in risk-bearing arrangements, connecting care management, primary care, and quality improvement . Worked with physician leaders to interpret utilization and quality reports, then organized targeted follow-up for chronic care gaps and high-use patient groups. Created referral and post-discharge tracking practices that gave clinic teams clearer visibility into network access and continuity of care. Supported contract performance reviews with cost and quality analysis, helping operational leaders distinguish local workflow issues from broader utilization trends. Introduced a process standardization cycle for referral and post-discharge tracking, comparing clinic records during recurring reviews and resolving handoff gaps to support continuous improvement . Worked with primary care teams to prioritize care-gap closure for chronic conditions, assigning patient outreach and follow-up based on utilization reports and overdue quality measures. Senior Director, Care Management MeridianCare Partners Jan 2001 - May 2006 Seattle, WA Managed clinical operations for care coordination programs, translating payer and provider priorities into consistent case review and follow-up practices. Introduced routine review of inpatient and post-discharge cases with nursing and physician partners, improving visibility into readmission risks and care transition needs. Prepared operational and quality reports for leadership, providing a clearer basis for staffing decisions, program adjustments, and partner discussions. Created a recurring inpatient case review with nursing and physician partners, flagging discharge barriers and arranging timely follow-up to address readmission risk and care transition needs. LEADERSHIP & AWARDS Led enterprise value-based care performance across 12 markets at Cedar Ridge Health, aligning senior clinical, finance, actuarial, network, and analytics leaders around shared measures and market accountability. Directed cross-market risk adjustment and quality operations at Blue Mesa Health Plan, coordinating provider, coding, compliance, and operations partners through audit preparation and remediation. EDUCATION Master of Health Administration University of Washington 1998 Seattle, WA Bachelor of Science, Public Health Oregon State University 1994 Corvallis, OR CERTIFICATIONS Certified Professional in Healthcare Quality (CPHQ) 2007 Medicare Advantage and Risk Adjustment Continuing Education 2015 PROFESSIONAL SKILLS Quality Measurement: Stars, HEDIS, CAHPS Risk and Coding: RADV, ICD-10-CM, CPT Healthcare Data: SQL, Microsoft Excel, Microsoft Access Reporting Platforms: Tableau, Microsoft Power BI, SAS Clinical Systems: Epic, Oracle Health, MEDITECH Office Software: Microsoft PowerPoint, Microsoft Word, Microsoft Outlook SKILLS Value-Based Care Strategy Population Health Medicare Advantage Risk Adjustment Revenue Integrity Stars and HEDIS CAHPS Quality Programs Medical Expense Management Total Cost of Care Utilization Management Network Performance Care Coordination Referral Management Healthcare Forecasting Executive Governance PROFESSIONAL AFFILIATIONS Member, National Association of Health Services Executives, contributing executive perspective on healthcare leadership and system performance. Member, American College of Healthcare Executives, participating in professional development and healthcare management community activities.

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