VBR Program Manager

Job not on LinkedIn

🔥 8 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $83k - $132.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Manage value-based reimbursement programs within an assigned market, lines of business and/or product • Manage risk-sharing or risk-bearing entities and Accountable Care Organization arrangements • Manage Quality/HEDIS/Medicare STARs Pay For Quality/Pay For Performance, value-based care incentives, Quality Affordability Initiatives, and advanced payment models • Evaluate potential opportunities and leverage data to inform and develop VBR programs • Coordinate with Finance and key business areas to develop near-real-time financial, quality and clinical performance reporting, dashboards, and data exports • Assist in developing VBR Program Office governance for contract tracking and approvals • Collaborate with Finance and Medical Economics teams to improve performance and reconciliation • Connect contracts to predictive modeling scenarios • Stratify populations based on revenue opportunity and clinical outcomes • Model contract terms, estimate payments, and reconcile against contracts • Conduct actuarial evaluation of program outcomes to drive opportunities and contracting • Build and run impact models • Work with national/market network teams and providers to improve performance • Engage the appropriate patient population to improve results • Integrate with provider systems and/or data sharing as applicable • Develop VBR enterprise protocols and SOPs • Identify and implement performance improvement initiatives for new health partner contracts and maintenance • Oversee and coordinate systematic population management initiatives • Participate in committees, subcommittees, and work groups • Maintain internal relationships with key business partners • Manage multiple projects, collect and analyze data, and disseminate findings to appropriate departments • Perform other requested job duties

🎯 Requirements

• 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 • Provider contracting or Provider relations experience preferred • Proficient with Microsoft Office, including Word, Excel and PowerPoint • Excellent written and verbal communication skills • High level of analytical and problem-solving skills • Ability to develop, prioritize and accomplish goals • Excellent analysis and reporting skills • Strong interpersonal skills and high level of professionalism • Effective listening and critical thinking skills • Understanding of the 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 • No licensure or certification required • May be required to travel occasionally

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Employee total well-being support • Equal Opportunity Employer environment fostering belonging and support for individuals of all backgrounds