Caroline Pires

About Caroline Pires

Value-based care leader with 8+ years across payer–provider partnerships, population health, and quality performance improvement. I specialize in translating value-based contract goals into practical, measurable programs that improve Cost and Utilization, HEDIS/CAHPS performance, strengthen documentation quality, and enable providers and ACOs to close gaps in care—at scale.I’m passionate about healthcare organizations that are building smarter, more integrated solutions for VBC—where accurate documentation, actionable clinical insights, and streamlined workflows directly improve outcomes, quality, and affordability.Core strengths: Value-Based Care Strategy • ACO/Provider Performance • HEDIS & CAHPS • Documentation & CMS Compliance • Root Cause Analysis • Data Issue Resolution • Performance Benchmarking • Cross-Functional Leadership • Process Improvement • Stakeholder Management • Salesforce • Advanced Excel/PowerPoint

Experience

1. Care Consultant Sr

   Anthem Blue Cross and Blue Shield

   May 2023 — Present · New York, NY, US

   Implement Anthem’s Medicare, Medicaid, and Commercial Value-Based program within 5 ACOs (Accountable Care Organization) across 4 markets, impacting a population of beneficiaries by demonstrating extensive knowledge of value-based contracts, population health, cost, utilization, and Payer and ACO operations.

Education

• Borough of Manhattan Community College

  Associate's degree

  2010 — 2010

• Baruch College

  Bachelor's degree

  2012 — 2013

Skills

• Analysis
• Marketing Communications
• Facebook
• Dreamweaver
• Adobe Photoshop
• Social Media Marketing
• Google Analytics
• Direct Track
• Digital Marketing
• Photoshop
• Doubleclick for Publishers (Dfp)
• Marketing
• Online Marketing
• Social Media
• Rackspace Cloud
• Sap
• Dmc
• Integrated Marketing
• Management
• Marketing Strategy
• Digital Media
• Salesforce
• Mailchimp
• Advertising
• Microsoft Office
• Online Advertising
• Newsletters