VBR Program Manager

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:

- 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 build 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 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 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

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 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:
$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 addit