Virginia Premier Health Plan, Inc.

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Director, Value Based Purchasing

Director, Value Based Purchasing

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4097

Job Description

Overview

This position is responsible for setting and implementing the strategy for managing value based purchasing contracting functions. The incumbent implements the strategy by developing and maintaining internal and external relationships that result in high-quality, cost-effective and efficient services.

 

Responsibilities

  • The Director of Value-Based Purchasing will oversee the successful coordination, negotiation and implementation of value-based contracts across all Medicare, Medicaid and other health plan products.
  • Educate providers on their performance in delivering high quality care and work collaboratively to improve HEDIS and risk scoring. Represent the team on joint operating and governance committees created with provider organization.
  • Work independently and collaboratively with project team to implement outwardly facing portal to implement new analytical models.
  • Serve as the subject matter expert for value based purchasing activities to include developing innovative programs designed to transition from fee-for-service reimbursement to a system based on value and population health using reimbursement methodologies that focus on optimizing outcomes and reducing costs.
  • Maintain an expertise in regulatory programs including PQRS/MIPS/MACRA, Meaningful Use, bundled payments, etc.
  • Develop strategic value based goals and programs across all health plan products
  • Demonstrated ability to collaborate effectively with cross-functional management staff and key business customers to achieve business and value based goals.
  • Identify and establish relationships with all large and/or critically important medical providers, integrated delivery systems, long-term services and supports, and provider networks.
  • Plan and facilitate value-based payment contract meetings with internal and external stakeholders to evaluate the effectiveness of the relationship, identify and implement strategies to address sub-optimal outcomes, and partner to move along the value-based payment continuum.
  • Assist with the development and implementation of contract negotiation strategies for the health plan.
  • Provides analytical support for value-based programs including independently monitoring and measuring the performance of the initiatives by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources.
  • Collaborate with the AVP of Network Development to set strategy for the department and spearhead major initiatives as needed.
  • Attract, train, develop, manage and retain high-performing staff to achieve necessary goals within the organization.
  • Partner with the Delegate Oversight Team (DOT) on value based initiatives
  • Works with Program Management to ensure the value based purchasing objectives and outcomes align with program goals.
  • Develop and maintain contracting Policies and Standard Operating Procedures (SOPs).
  • Perform other managerial duties as required.


Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s degree in Business Administration, Healthcare Management or related field. Master’s degree preferred.

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Knowledge of Lean, Six Sigma, and Project Management
  • Excellent understanding of Medicare and Medicaid healthcare insurance markets, the HMO concept and business operations.
  • Previous experience in hospital or physician contracting.
  • Exceptional organization skills
  • Excellent oral & written communication skills
  • Demonstrated leadership skills.
  • Ability to manage multiple projects while meeting deadlines and achieving business goals.
  • Ability to supervise staff and promote successful performance. 

WORK BACKGROUND/EXPERIENCE

  • 5-7 years of management experience with increasing responsibility

Physical requirements

  • Physical health sufficient to meet the ergonomic standards and demands of the position

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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