Job Summary:The Value Based Reimbursement (VBR) Program Manager is responsible for managing value-based reimbursement programs within an assigned market, lines of business and/or product. Products to include, but not limited to, managing risked sharing or risk bearing entities and Accountable Care Organizations (ACOs) arrangements, Quality/HEDIS/Medicare STARs Pay For Quality/Pay For Performance, value based care incentives, Quality Affordability Initiatives (QAI), and advanced payment models (e.g. bundles, episodic care reimbursement, etc.).
Essential Functions:- Assist in the evaluation of potential opportunities and understand the potential value of an intervention, leveraging data to inform and develop VBR programs
- Coordinate with Finance and key business areas on developing close to real time reporting of financial, quality and clinical performance including build dashboards and data exports to track performance
- Assist in the development of the VBR Program Office governance for VBR contract tracking and approvals
- Work closely with Finance and Medical Economics teams to improve performance and reconciliation
- Connect contract to predictive modeling scenarios
- Stratify populations based on revenue opportunity and clinical outcomes
- Model contract terms to estimate payments reconcile against contract
- Actuarial Evaluation of program outcomes to drive opportunities and contracting
- Build and run impact models
- Work closely with national/market network teams and providers to improve performance
- Engage the right patient population to improve results
- Integrate with provider systems and/or data sharing as applicable
- Develop VBR Enterprise protocols and SOPs to align market and enterprise functions
- Participate in identifying and implementing performance improvement initiatives to improve process of implementation of new health partner contracts and maintenance
- Oversee and coordinate systematic population management initiatives
- Participate in key committees, subcommittees, and work groups as necessary
- Maintain strong internal relationships with key business partners
- Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
- Perform any other job duties as requested
Education and Experience:- Bachelor's degree in business administration, or related field or equivalent work experience is required
- Minimum of five (5) years of experience in value-based reimbursement design, methodologies and/or VBR contracting, data analysis, reporting, or data support is required
- Previous experience in healthcare, preferably in managed health plan industry is preferred
- Provider contracting or Provider relations experience is preferred
Competencies, Knowledge and Skills:- Proficient with Microsoft Office to include Word, Excel and PowerPoint
- Excellent written and verbal communications skills
- High level of analytical/problem solving skills
- Ability to develop, prioritize and accomplish goals
- Demonstrates excellent analysis and reporting skills
- Strong interpersonal skills and high level of professionalism
- Effective listening and critical thinking skills
- Understanding of healthcare payer industry
- Effective problem-solving skills with attention to detail
- Ability to work independently and within a team
- Excellent collaboration skills
- Ability to create and maintain excellent working relationships
Licensure and Certification:Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- May be required to travel occasionally
Compensation Range:$83,000.00 - $132,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):Salary
Organization Level Competencies - Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.#LI-EM1
Brand=CareSource
