Value Based Reimbursement Program Manager (Remote)
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:
Evaluate potential opportunities and understand the potential value of an intervention, leveraging data to inform and develop VBR programs
Build and design standardized APM/VBR Models, test performance scenarios and generate value based contract templates
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
Translate contract terms/KPIs into code as applicable
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
Review Value Based Reimbursement (VBR) reports to validate accuracy and distribute to health partners as appropriate
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
Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
Perform any other job duties as requested
Education and Experience:
Bachelors 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:
None
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:
$81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidates education, training, and experience as well as the positions scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employees total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- 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. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Apply Now
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:
Evaluate potential opportunities and understand the potential value of an intervention, leveraging data to inform and develop VBR programs
Build and design standardized APM/VBR Models, test performance scenarios and generate value based contract templates
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
Translate contract terms/KPIs into code as applicable
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
Review Value Based Reimbursement (VBR) reports to validate accuracy and distribute to health partners as appropriate
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
Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
Perform any other job duties as requested
Education and Experience:
Bachelors 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:
None
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:
$81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidates education, training, and experience as well as the positions scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employees total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- 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. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Apply Now