Hospital Value- Provider - Market; live in 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.

• 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 may be accepted in lieu of required education
• Five (5) years of experience in value-based reimbursement/payment design, methodologies and/or V  contracting, provider contracting, provider performance, managed care operations, population health, or healthcare quality required
• Experience working with hospitals, health systems, physician organizations, or Accountlbe Care Organizations (ACO) required
• Medicaid Managed Care experience is strongly preferred
• Experience leading market-based provider incentive, quality, or value-based payment programs preferred
• Knowledge of state healthcare market, provider networks, and Medicaid programs preferred
• Demonstrated experience building collaborative relationships with providers, hospitals, and healthcare system stakeholders to achieve quality and financial performance goals preferred

• Proficient with Microsoft Office to include Word, Excel and Power Point
• Excellent written and verbal communications skills
• High level of analytical/problem solving skills
• A…