Regional Manager, Value-Based Programs - REMOTE

Regional Manager Value Based Programs

The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts. Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs.

Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP / VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality / Risk, Director of Value Based Programs, and local health plan resources.

Responsible for knowledge of local market / LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements. Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis. Supports launching of value-based programs in new markets / expansion of existing markets to achieve goals in RFPs and financial forecasts.

Ensure Value Based Contracting / Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter. Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance. Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment. Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance.

Required Education : Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience.

Required Experience : 4+ years managed care experience. Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and / or Medicare. Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance. Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding. Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results. Proven ability to innovate and manage complex processes across multiple functional areas. Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships. Excellent presentation and communication skills.