Hospital Value- Provider - Market; live in Las Vegas, Nevada- HYBRID

Job Summary

The Hospital Value-Based Provider Programs Manager – Markets is responsible for the development, implementation, oversight, and performance of value-based payment initiatives within the market. This position serves as the primary market lead for hospital and provider value-based payment programs, ensuring successful contract implementation, achievement of quality and financial objectives, and alignment with market-specific strategic priorities. This role is accountable for driving provider engagement, monitoring program performance, supporting quality improvement efforts, and managing hospital value-based payment arrangements that return quality withhold funds to the state health plan through achievement of contractual quality measures and performance targets.

In addition to value-based payment initiatives, this position oversees strategic market programs including provider performance initiatives designed to improve health outcomes, provider experience, and operational efficiency. This position must reside in Nevada.

The Hospital Value-Based Provider Programs Manager – Markets is responsible for the development, implementation, oversight, and performance of value-based payment initiatives within the market. This position serves as the primary market lead for hospital and provider value-based payment programs, ensuring successful contract implementation, achievement of quality and financial objectives, and alignment with market-specific strategic priorities. This role is accountable for driving provider engagement, monitoring program performance, supporting quality improvement efforts, and managing hospital value-based payment arrangements that return quality withhold funds to the state health plan through achievement of contractual quality measures and performance targets.

In addition to value-based payment initiatives, this position oversees strategic market programs including provider performance initiatives designed to improve health outcomes, provider experience, and operational efficiency. This position must reside in Nevada.

• Lead the implementation, monitoring, and optimization of hospital value-based payment programs, ensuring contractual performance expectations, quality outcomes, and financial targets are achieved.
• Develop and execute strategies to maximize quality withhold performance and return quality incentive payments to the market health plan through provider engagement, education, performance monitoring, and corrective action planning.
• Serve as the market subject matter expert for hospital value-based payment programs, providing leadership and operational guidance to internal stakeholders and contracted provider organizations.
• Oversee additional programs, including provider participation, regulatory compliance, stakeholder engagement, reporting, and program performance monitoring.
• Collaborate with provider organizations and internal business partners to identify opportunities for care gap closure, improved quality outcomes, appropriate utilization, and enhanced member experience.
• Monitor provider performance against contractual quality metrics and facilitate action plans designed to improve results and support achievement of program goals.
• Participate in key committees, subcommittees, and work groups as necessary.
• Maintain strong internal and external relationships with key business partners.
• Manage multiple projects, collect and analyze data, and disseminate information to appropriate departments as necessary.
• Perform any other job related duties as requested.

• Bachelor's degree in Business Administration, Healthcare Administration, Public Health, Finance, Nursing, or related field
• Equivalent years of relevant work experience…