Value-Based Programs Lead – VBP Design

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

📋 Description

• Facilitate successful value-driven relationships with providers, emphasizing their experience and objectives related to value attainment.

• Oversee comprehensive operational support for specialized Medicaid value-based payment initiatives.

• Innovate value-based payment (VBP) models tailored for behavioral health, maternity, specialty providers, and social determinants of health.

• Establish pathways for transitioning providers from volume-based to value-based care.

• Ensure alignment of new VBP model development with segment roadmaps, Medicaid contractual obligations, and RFP commitments.

• Evaluate financial, utilization, and performance data to pinpoint opportunities for quality enhancement and reduction in total cost of care.

• Formulate VBP payment strategies and model designs, incorporating payment logic, performance metrics, benchmarks, and financial terms.

• Create and enhance provider reporting packages that clarify overall performance and detailed analytics.

• Collaborate with finance to conduct impact assessments and modeling for emerging VBP models.

• Work with cross-functional teams to operationalize and implement new VBP models.

• Identify and assist in addressing operational deficiencies.

• Track performance KPIs of VBP models and refine model design using feedback and performance data.

• Transform strategic vision into models that can be tested and scaled across various markets.

⛳️ Requirements

• A bachelor's degree is required.

• At least five (5) years of experience in managed care operations, provider reimbursement and analytics, and value-based care.

• A minimum of two (2) years of direct experience in designing, structuring, and implementing value-based payment (VBP) strategies and models for specialty providers.

• Familiarity with pay-for-performance, bundled payments, accountable care, shared savings, and shared-risk arrangements.

• Proficient in utilizing financial, utilization, quality, and performance data to design and model VBP agreements.

• Experience in establishing baselines and benchmarks, recognizing cost and utilization opportunities, setting performance objectives, and developing incentive, shared-savings, and risk methodologies.

• Capability to operate effectively in a matrixed environment.

• Specialized knowledge in Medicare and/or Medicaid managed care.

• Ability to identify, structure, and address complex business challenges.

• Strong interpersonal, organizational, written, oral communication, and presentation skills.

• Demonstrated experience in crafting and presenting to management team members.

• Preferred: A master's degree.

• Preferred: Expertise in VBP financial modeling and impact analysis.

• Preferred: Direct experience with a Medicaid managed care health plan.

• Ability to work remotely in a dedicated space free from ongoing interruptions.

• Home internet connection with a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Remote work arrangement.

• Up to 10% travel for onsite meetings.

• Dedicated home workspace and internet requirements supporting remote work.