VBR Program Manager

Job Summary

The Value Based Reimbursement (V ) 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.).

The Value Based Reimbursement (V ) 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.).

• Assist in the evaluation of potential opportunities and understand the potential value of an intervention, leveraging data to inform and develop V  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 V  Program Office governance for V  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 V  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

• 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 V  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

• Proficient with Microsoft Office to include Word, Excel and Power Point
• 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…