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Manager, Value-Based Programs

Posted on Dec 26, 2019 by Premier Physicians Centers

Westlake, OH 44145
Health Care
Immediate Start
Annual Salary
Full-Time

Premier Physicians is seeking a full time Manager of Value-Based Programs. We are located in Westlake, OH,

Essential Functions:

  • Works directly with the Director, Clinical Integration & Utilization Management, EHR Supervisor, and training supervisor to develop and implement programs to improve clinical quality measures and reach internal quality goals.
  • Assists Director in the development of the Quality Improvement Plan and annual evaluation.
  • Will work with payors, ACOs, and hospital or physician groups to secure value based agreements. Responsible for successful negotiation and execution of agreements.
  • Works directly with payers, providers, and other organizations to identify and establish best practices for achieving optimal results in value-based programs. Working with operational teams, will coordinate and participate in regular Quality Improvement meetings with payers. Work with payors to establish meeting agendas, coordinates internal cross-departmental internal meetings to prepare for payor meetings.
  • Communicates new programs to senior leadership and operational stakeholders to ensure high likelihood of successful achievement of program goals. Continually evaluates outcomes and develops tactics for improvement.
  • Must work with IT and other internal departments to develop tracking mechanisms to identify patients attributed to a value-based program, assess performance relative to goals, and report to external and internal stakeholders. Performance goals include financial and clinical measures.
  • Provides project management or appropriate oversight to implement key initiatives.
  • Serves as a subject matter expert on local and national managed care issues trends related to care transformation innovative payment models. Identifies contract and program opportunities, regulatory changes, industry practice changes that can potentially impact revenues, and communicates to senior leadership and Premier Physician Centers operational stake holders.
  • Manages assigned projects and initiatives including: insurance payors, Premier Physician Centers reporting needs, develops project plans, and initiates required implementation of steps needed to achieve goals and timelines for pay-for-performance, shared savings, and quality initiatives; assesses current state, analyzes opportunities, and gains support for required changes.
  • Develops and maintains effective working relationships with insurance payors that are responsible for the management of contracts with healthcare providers.
  • Participates in the negotiation of value-based contracts relating to language, financial structures, amendments, and also by monitoring financial and quality performance to maximize opportunities for net revenue improvement, volume/growth, and effectiveness.
  • Provides support for teams to ensure the organization maintains compliant in all value-based quality program requirements. Stays abreast of program changes and implements them as needed and supported.
  • Establishes and maintains strong partnerships with key stakeholders to ensure timely and accurate communication of program requirements and updates.
  • Assists with the coordination of data evaluations and performance audit activities.
  • Supports appropriate staff regarding understanding of MIPS and HEDIS measures, quality improvement principles and standards, gap analyses, and acts as a liaison to facilitate quality improvement efforts between Premier Physician Centers and the insurance payors.
  • Apply organizational and multi-tasking skills to support implementation and management of new initiatives related to direct contracting to include development of applicable relationships with third party administrators.
  • Responsible for managing all internal and external required client meetings regarding discussion of value-based contract performance to include creating the agenda, validating materials and content for review, as well as facilitating the meeting.
  • Manages the implementation of new reimbursement mechanisms for value based Contracts, or other innovative models to include shared savings and/or downside risk components.
  • Participates in the development and implementation of new types of structural contracting mechanisms such as alliances, subcontracts, and contractual joint ventures which will benefit Premier Physician Centers in securing managed care contracts.
  • Acts as department liaison for internal quality and financial performance inquiries and acts as a Premier Physician Centers representative for insurance payors engagement activities (ie coordination of enrollment meeting participation, quarterly reviews, other presentations regarding as needed).
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Accountable for oversight and facilitating Quality Improvement activities across all Premier Physicians Centers.

Premier Physicians Centers is an equal opportunity Employer.

Reference: 818148634

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