This position is responsible for the full strategic relationship across a portfolio of enterprise payer accounts — health plans, managed care organizations, and other risk-bearing entities — for the Veradigm Payer Products portfolio. The Veradigm Outcome Executive (VOE) is the most senior client-facing individual contributor for these accounts, with particular focus on risk adjustment and quality programs (HEDIS and Stars) and on payer-provider clinical data exchange. Serving as the integration layer across Sales, Consulting, Support, and A/R, the VOE drives retention, expansion, and wallet share through deep knowledge of each plan’s medical economics, quality and risk performance, and regulatory obligations. The role operates with significant autonomy and is fully accountable for C-suite engagement, annual account planning, QBR cadence, and measurable revenue outcomes.

CORE RESPONSIBILITIES

• Serve as the primary strategic partner to C-suite and senior functional leadership within an assigned portfolio of enterprise payer accounts — including Chief Medical Officer, Chief Actuary, quality and Stars leadership, risk adjustment leadership, and Chief Information Officer — owning the full client relationship across quality, risk, network, and regulatory touchpoints

• Build and maintain executive-level relationships through on-site visits, quarterly business reviews (QBRs), and proactive engagement, establishing Veradigm as a trusted long-term partner

• Understand and document each plan’s enterprise priorities — Stars and HEDIS targets, risk adjustment accuracy, medical loss ratio pressure, value-based care strategy, and interoperability mandates — and develop and execute annual account plans focused on retention, optimization, and expansion

• Analyze plan membership, line-of-business mix, and product utilization data to identify whitespace across Medicare Advantage, Medicaid, commercial, and ACA lines of business; translate findings into actionable pipeline and sales strategy

• Position Veradigm risk adjustment and quality solutions against each plan’s annual program cycle — chart retrieval and review, supplemental data submission, gap identification and closure, and audit readiness — and align proposal timing to that cycle

• Position payer-provider clinical data exchange solutions, connecting plan requirements for clinical data acquisition, interoperability compliance, and prior authorization workflow to Veradigm’s provider network and data assets

• Drive ACV quota attainment and MBO performance through disciplined pipeline management, accurate forecasting, and timely opportunity progression

• Navigate payer procurement, security review, and contracting processes, coordinating Legal, InfoSec, and Privacy to move enterprise agreements and data use terms to signature

• Advocate internally for client needs — surface product feedback, coordinate cross-functional issue resolution, and represent the payer voice in roadmap and strategy discussions

• Partner with Consulting, Support, and A/R to ensure dependable delivery and early resolution of at-risk situations before they affect retention

• Maintain deep working knowledge of CMS and NCQA program mechanics — risk adjustment models and submission, RADV audit exposure, HEDIS measure specifications, the Medicare Advantage Stars program, and federal interoperability and prior authorization rules — to credibly advise executive stakeholders

• Conduct whitespace and competitive analysis to expand Veradigm’s footprint within each plan and identify new use cases across additional lines of business

Compensation Range:

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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