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 include managing risk 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 building 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 and 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 for 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 including Word, Excel, and PowerPoint
• •Excellent written and verbal communications skills
• •High level of analytical and 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

Working Conditions

• •General office environment; may be required to sit or stand for extended periods of time
• •May be required to travel occasionally

Compensation

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.