Director, Value-Based Programs
RemoteUnited States
Job Summary
Design and implement strategies to continuously improve value-based program results, focusing on accuracy, compliance, and completeness in risk adjustment revenue across all government lines of business. Lead the development of annual plans by state and line of business, identifying providers for contracts, setting financial and quality targets, and managing reporting responsibilities. Collaborate with risk adjustment and quality leadership to guide contracting strategies, present performance data to senior leadership, and oversee internal monitoring of existing contracts. Manage team performance through coaching, development, and regular meetings while driving strategy and collaboration within a matrixed organization.
Required Qualifications
- At least 8 years of managed care experience, including value-based programs (VBP) experience, or equivalent combination of relevant education and experience.
- At least 3 years of management/leadership experience.
- Experience leading value-based program and contract design, and implementation for Medicaid, Medicare, and/or Marketplace programs.
- Experience in a complex health care delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliance.
- Knowledge of value- based programs (VBP), risk adjustment models, quality metrics such as Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare STARS, and coding.
- Knowledge of medical economics and financial reporting, and ability to walk stakeholders through complex financial reconciliations.
- Leadership skills, including 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, and proven ability to develop internal enterprise relations, and external strategic relationships.
- Excellent verbal and written communication skills, including ability to present at an executive level to internal/external stakeholders.
- Microsoft Office suite and applicable software program(s) proficiency.
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