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
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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