Director, VBR & Risk Adjustment

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise and evaluate physician and standard health partner contracting along with ongoing relationships within the plan's physician and health partner network.

• Ensure provider satisfaction levels are achieved.

• Assist in analyzing and implementing initiatives aimed at enhancing quality outcomes and risk adjustment scoring.

• Oversee and monitor network access standards, including recruitment for network deficiencies and/or new product development.

• Create regional business strategies to broaden the service area, boost plan enrollment, and enhance network quality outcomes.

• Represent CareSource in the local market through community involvement, board memberships, and participation in trade/professional organizations.

• Monitor financial activities of the plan, including budgeting and forecasting, to ensure financial objectives are met.

• Maintain collaborative relationships with providers and regulatory agencies.

• Convert issues, goals, and objectives into practical, integrated solutions and services.

• Oversee the development and implementation of policies, standards, benchmarks, metrics, and quality controls.

• Design project plans, conduct studies, provide recommendations, and formulate implementation plans for operational enhancements.

• Develop and coordinate performance improvement measurement, reporting, and feedback systems.

• Manage contract management databases, instruct site-specific user administrators, create user profiles, and coordinate IT upgrades.

• Secure resources, define roles and responsibilities, set direction, and coordinate initiatives for operational performance and division objectives.

• Lead or engage in vendor selection, contract development, and compliance for provider network operations tools and services.

• Communicate professionally across all levels of the organization.

• Oversee and manage support teams, including hiring, supervision, development, and evaluation of colleagues.

• Prepare regular reports and presentations for executive leadership.

• Stay informed about relevant federal, state, and local laws and regulations.

• Perform other related duties as assigned.

⛳️ Requirements

• A Bachelor's degree in management, healthcare management, or a related field is required.

• Equivalent years of relevant work experience may be accepted in place of the required education.

• A minimum of five (5) years of experience in healthcare network management is required.

• At least five (5) years of leadership/management experience is required.

• Managed Care experience is preferred.

• Strong understanding of Value Based Contracting methodologies and operations and/or experience in healthcare quality.

• Advanced proficiency in Microsoft Office, including Outlook, Word, and Excel.

• Ability to operate a smartphone, iPad, or other mobile communication devices.

• Knowledge of provider contracting and provider network operations.

• Understanding of regulatory requirements for Marketplace provider network operations.

• Excellent oral, written, and interpersonal communication skills.

• Strong financial acumen.

• Knowledge of the managed care industry, trends, accreditation, quality improvement, and NCQA provider network requirements.

• Ability to work independently as well as collaboratively within a team environment.

• Attention to detail and expertise in work plan creation, implementation, and evaluation.

• Business acumen and strategic thinking with the ability to execute tactically.

• Capability to adapt to shifting priorities, multitask, work effectively under pressure, and meet deadlines.

• Proven ability to identify improvement opportunities and lead change initiatives.

• Demonstrated success in leading teams focused on consumer/member experience, showing empathy, compassion, and measurable results.

• Proven track record in driving continuous improvement to enhance member experience and track results.

• A Master's degree in business, healthcare management, or a related field is preferred.

• No licensure or certification is required.

🏝️ Benefits

• Bonus opportunities linked to company and individual performance may be available.

• A substantial and comprehensive total rewards package.

• Comprehensive total well-being support.

• Remote work arrangement available.

• Up to 25% travel required for meetings, trainings, and conferences.