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:

• 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:

$79,800.00 - $127,600.00

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. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level 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, including disability and veteran status. We are committed to a diverse and inclusive work environment.