Job Summary

Position Summary

A growing healthcare organization is seeking an experienced Fractional Chief Financial Officer to provide executive-level financial leadership as the organization expands its Medicare, value-based care, and risk-based healthcare operations.

The Fractional CFO will oversee financial strategy, forecasting, risk management, financial controls, provider economics, budgeting, and executive reporting. This role requires a strong understanding of Medicare reimbursement, value-based payment models, healthcare claims economics, shared savings/shared risk structures, and financial reporting requirements associated with federal healthcare programs.

Previous experience working with an Accountable Care Organization or comparable Medicare value-based care organization is required. Healthcare finance experience is also required.

The successful candidate must be able to operate at both the strategic and hands-on level and work closely with executive leadership, clinical leadership, compliance, legal counsel, accounting professionals, data teams, and participating healthcare providers.

Key Responsibilities

The Fractional CFO will be responsible for:

Leading the organization's financial strategy and long-range financial planning.
Developing financial models for Medicare and value-based care populations.
Forecasting medical expenditures, healthcare utilization, revenue, and financial performance.
Monitoring performance against applicable healthcare benchmarks and contractual requirements.
Modeling shared savings, shared risk, prospective payment, and other value-based reimbursement arrangements.
Evaluating potential downside financial exposure and establishing appropriate reserves.
Advising executive leadership on financial risk associated with provider network growth and beneficiary population growth.
Developing and maintaining annual budgets and rolling financial forecasts.
Managing cash-flow projections and working-capital requirements.
Establishing and monitoring financial controls, approval processes, and segregation of duties.
Providing executive oversight of bookkeeping and accounting functions.
Reviewing monthly financial statements and identifying material variances.
Coordinating with external CPAs, auditors, tax professionals, attorneys, and other financial advisors.
Supporting financial guarantee, surety, or other risk-security requirements associated with federal healthcare programs.
Developing provider-level financial models and incentive methodologies.
Evaluating the economics of participating physician practices, provider groups, and health systems.
Monitoring healthcare claims and utilization trends that affect total cost of care.
Working with data and analytics teams to translate claims and clinical data into actionable financial information.
Preparing financial reports for executive leadership and the Governing Body.
Supporting financial documentation required for regulatory reviews, audits, and healthcare program reporting.
Advising leadership regarding financial arrangements with physicians, vendors, and other healthcare entities in coordination with legal and compliance counsel.

Required Qualifications

Candidates must have:

Previous direct experience working with an Accountable Care Organization or similar Medicare value-based care organization.
Significant healthcare finance experience.
Experience with Medicare reimbursement and value-based payment arrangements.
Experience with shared savings, shared risk, total-cost-of-care, or population-health financial models.
Strong understanding of healthcare claims and utilization data.
Experience with healthcare budgeting, forecasting, and financial modeling.
Experience presenting financial information to executive leadership, boards, or governing bodies.
Strong understanding of financial controls and GAAP-based financial reporting.
Ability to work effectively with physicians, healthcare executives, attorneys, compliance professionals, accountants, and data teams.

Preferred Experience

Strong preference will be given to candidates with prior experience involving:

Medicare Shared Savings Program
ACO REACH or other CMS Innovation Center models
Medicare risk arrangements
Prospective or capitated healthcare payments
Medicare benchmarking
Risk adjustment
Provider incentive compensation
Shared savings distributions
Total cost of care
Healthcare actuarial modeling
Federal healthcare financial audits
Financial guarantees or surety requirements
Multi-state physician or provider networks

CPA, MBA, MHA, or comparable advanced credentials are preferred, although direct operational experience with Medicare value-based care models is more important than credentials alone.

Ideal Candidate

The ideal candidate has previously served in a senior finance role for an organization participating in Medicare value-based care and can independently answer questions such as:

Are healthcare expenditures performing according to forecast?
Where are the largest areas of medical-cost variation?
What is the organization's potential upside and downside financial exposure?
How much operating and risk reserve should be maintained?
How should provider incentives and financial distributions be structured?
Which participating practices are contributing positively or negatively to financial performance?
What utilization trends require operational intervention?
What financial risks should leadership address before they materially affect performance?

Expected Time Commitment

Approximately 10–20 hours per week initially, with flexibility during periods of heightened financial activity, regulatory reporting, budgeting, provider onboarding, financial reconciliation, or other major program milestones.

After the financial infrastructure is established, the role may stabilize at approximately 8–15 hours per week.

Pay: $125.00 - $225.00 per hour

Expected hours: 5.0 – 25.0 per week

Application Question(s):

Tell us about the ACO or value-based care organization you previously worked with. What model was it in, what was your role, and what financial responsibilities did you personally own?
How have you modeled or monitored total cost of care, shared savings, or shared losses for a Medicare population? What data and assumptions did you use?
Describe a time when financial or utilization data showed that an ACO or value-based care organization was at risk of missing its financial target. What did you identify, and what actions did you recommend?
What experience do you have developing provider incentive or shared-savings distribution methodologies? How did you balance financial performance, quality, compliance, and provider engagement?
If you joined a new Medicare value-based care organization today, what financial dashboards, controls, forecasts, and reports would you establish in the first 90 days?

Work Location: Remote

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