Value Based Reimbursement Strategist

UPMC Senior Communities • $80K — $95K *
Pittsburgh, PA 15237In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree in business, health care, or related field; 3-5 years of relevant experience in health care consulting or value-based reimbursement programs.
  • Master's degree in business or health care preferred.
  • Strong analytical and organizational skills with excellent written and verbal communication abilities.
  • Experience in data handling and interpretation with a focus on strategic planning.
  • 3-5 years of demonstrated experience in data analysis and interpretation related to strategic plan development.
  • Leadership and personnel management experience required.
  • Clinical training or experience in outpatient settings preferred, especially with presentations to healthcare leadership.

Responsibilities

  • Develop a data-driven strategic plan for clinical, financial, and quality goals in collaboration with Value-Based Reimbursement Partners.
  • Serve as the primary liaison for assigned Value-Based Reimbursement Partners within UPMC Health Plan.
  • Coordinate communication between UPMC Health Plan and community-level providers to ensure effective two-way dialogue.
  • Maintain understanding of quality metrics to optimize incentive earnings for Value-Based Reimbursement Partners.
  • Ensure alignment of internal UPMC Health Plan departments with the needs of assigned Partners through effective communication.
  • Transform strategic plans into actionable objectives with clear milestones for Partner performance improvement.
  • Collaborate with field-based teams to implement improvement strategies, streamline workflows, and enhance care delivery.

Benefits

  • Hybrid work model requiring three days in the office.
  • Opportunity to work directly with primary care leadership and impact value-based care delivery.
  • Access to ongoing professional development and training related to value-based reimbursement.
  • Collaborative working environment within a matrixed healthcare organization.
Full Job Description
Purpose:

Turn Data Into Better Care - and Better Returns. As a Value-Based Reimbursement Strategist, you'll work side-by-side with primary care leadership to analyze performance, identify improvement opportunities, and lead clinical and financial strategies that drive value-based success. This position is directly responsible for developing and implementing the value creation strategy for each of the primary care provider groups (Partners) enrolled in the UPMC Health Plan's Value-based Reimbursement program.

In this role, the Value-Based Reimbursement Strategist works directly with each Partner's dedicated leadership while coordinating across UPMC Health Plan internal stakeholders to develop and implement clinical, financial, and quality-specific goals and strategies to improve value-based care delivery for Health Plan members. The ideal candidate for this position is a highly skilled subject matter expert in value-based reimbursement programs for primary care and can provide strategic, hands-on support to Partners by (1) analyzing and synthesizing Partner-specific performance data; (2) identifying targeted opportunities for improvement; and (3) coordinating and implementing in collaboration with the Partner and UPMC Health Plan on Partner-specific clinical improvement strategies. This job will be held responsible for Partners achieving specific ROI targets and/or performance-based targets agreed upon under the value-based reimbursement arrangement. The individual in this role must be able to work collaboratively in a matrixed environment, have strong inter-personal skills, be organized and self-directed, and enthusiastically represent the Organization and its mission and goals.

This role is Hybrid and requires 3 days per week in office in Downtown Pittsburgh

Responsibilities:

  • Develops a data-driven strategic plan related to clinical, financial, and quality goals in conjunction with each assigned Value-Based Reimbursement Partner. Uses this plan to align stakeholders within UPMC Health Plan regarding priorities for outreach and collaboration with the Partner.
  • Acts as the primary liaison within UPMC Health Plan for all assigned Value-Based Reimbursement Partners.
  • Coordinates with the Value-Based Reimbursement field team to ensure two-way communication between UPMC Health Plan and the community-level providers and their office staff.
  • Maintains a strong understanding of quality as it relates to the shared goals of UPMC Health Plan and Value-Based Reimbursement Partners. Assists with prioritizing quality-related interventions to maximize incentive earnings for each Value-Based Reimbursement Partner.
  • Coordinates among the internal UPMC Health Plan departments with respect to the necessary communications to all assigned Value-Based Reimbursement Partners and their leadership teams.
  • Operationalizes the strategic plan for an assigned Partner with clear objectives and milestones and works with the Partner and internal stakeholders to achieve the performance targets and goals identified.
  • In implementing the Partner-specific strategic plan, the Value-based Reimbursement Strategist works very closely with the Value-based care field-based team, assisting in the development of improvement strategies that will support primary care providers in using analytical tools, changing practice workflows, and applying continuous quality improvement methodologies to achieve targeted outcomes.
  • Prepares all Value-Based Reimbursement-specific presentations and communications and manages the flow of information back to each Value-Based Reimbursement Partner with respect to other UPMC Health Plan initiatives.


Qualifications:

  • Bachelor's Degree in business, health care, or related field and 3-5 years of related experience in health care consulting, managed care especially specific to provider networks or population health management, and/or value-based reimbursement programs required.
  • Master's degree in business, health care, or related field preferred.
  • Analytical and organizational skills. Excellent written and verbal communication skills.
  • Experience in handling and interpreting data.
  • 3-5 years of clearly demonstrated experience in data analysis, interpretation, and strategic plan development.
  • Demonstrated skills and experience in leadership and personnel management.
  • Clinically trained and/or demonstrated experience working in outpatient clinical settings and experience presenting to physicians and health care leadership preferred.

About UPMC Senior Communities

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Join UPMC Senior Communities to assist in transforming the experience of aging through top-tier care and wellness programs. This is an opportunity to be part of a team that values leadership, diversity, and innovation in the healthcare sector. Lead in a unique role where skills in healthcare, empathy, and leadership converge to enhance the lives of seniors. UPMC Senior Communities stands at the forefront of the industry, integrating advanced technology and personalized care practices. Engage with a professional network of healthcare providers and administrators dedicated to pioneering improvements in senior living. Collaborate with over 3,000 dedicated professionals across various facilities.

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