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Now hiring for the following position. To apply, please e-mail a cover letter and resume to: email@example.com
Value Based Care Director
The Director of Value-Based Care serves as a thought leader in the development and implementation of alternative payment models. The director provides expertise in value-based payment transformation methodologies which align and support the development of Starling’s competencies in value-based programs and the growth of the clinically integrated network. The director collaborates with senior management and clinical leadership to develop innovative commercial and government payments models, which may include accountable care organizations, bundled pricing, episodes of care, risk-based contracts and specialty medical homes for specific population segments. The director works with clinical leadership to identify performance improvement opportunities. The director also plays an integral role in creating managed care contract payment and incentive payment distribution models that incentive and reward high-quality care achieved through valued-based contracts.
- Position will be the principle in managing Starling’s value-based agreements including participating in and supporting contract negotiations and reviewing proposed agreements.
- A primary focus of this position will be to develop tracking mechanisms to assess performance across value-based contracts for Starling. Contracts include commercial and Medicare Advantage arrangements as well as Starling’s Medicare Shared Savings Program (MSSP). Performance components include cost of care, clinical quality metrics, and efficiency measures. Makes recommendations based on performance results for future contract renewals. Evaluates new contracts with respect to performance metrics including the reasonableness of performance standards and administrative requirements.
- Working with the Starling contracting team takes the lead role in reviewing payer settlements/ reconciliations related to all value-based agreements.
- Working with the Starling contracting team and senior leadership at Starling takes the lead in developing and preparing a communication program regarding performance under value-based contracts to Starling’s physicians and practice managers. Prepares executive summaries for senior management on contracting efforts and results.
- Stays up to date with current trends in cost and quality standards as well as with CMS’ Innovation Center for trends in Medicare alternative payment mechanisms.
- Works with payor partners to identify key contract elements for successful execution/operations (e.g., provider rosters, JOC meetings, bank accounts, reconciliation timing, data & analytics requirements, etc.).
- Works closely with health plans to develop and monitor data to support evolving risk, pay for performance, and ACO/population health initiatives.
- Has primary responsibility for coordinating and managing regular Joint Operating Committee (JOC) meetings with payers. Work with payors to establish meeting agendas, coordinates internal cross-departmental internal meetings to prepare for payor meetings.
- Leads value-based payment and alternative payment model projects. Facilitates the group process with senior administrators and faculty. Perform sophisticated analysis including developing financial and operational models, evaluating contract performance, environmental trends, core capabilities, competitive profile, and creating a gap.
- Develops Board documents and analyses as requested.
- Builds strong relationships with external payers and internal leadership and staff to support optimal patient care, service delivery, payment, program compliance, and data validation.
- Evaluates local and national managed care issues trends related to care transformation innovative payment models. Identifies contract and program opportunities, regulatory changes, industry practice changes that can potentially impact revenues and operations.
- Supervises direct report(s) & other duties as assigned.
Relationships (Reports to, Supervises)
- Reports to Chief Executive Officer.
- Establishes and maintains effective working relationships with providers, managers, other administrative staff, vendors, patients and the public.
- Supervises Value-Based Care team.
Qualifications (Education, Experience, Additional Skills & Requirements)
- Bachelor’s Degree from a four-year college or university is required.
- An MBA or equivalent is highly desirable.
- Must hold a minimum of 5 years of related health care experience, and a record of successfully completing similar duties, demonstrating considerable knowledge of health care organizations, operations, finance, quality, program planning, and managed care.
- In-depth understanding of provider contracting, provider development, delivery system design, quality, and medical cost management, contracting/reimbursement, etc.
- Proven experience in the successful negotiation of contract rates and terms with sophisticated and profitable established managed care and provider organizations.
- Experience in negotiating existing and new provider hospital, physician, and ancillary contracts.
- Prior experience with value-based/alternative payment models.
- Ability to interact effectively with all levels of administrative and medical staff and to facilitate the progress of multidisciplinary personnel teams in the pursuit of common goals and objectives.
- Requires knowledge of analytic software including spreadsheet (Excel), database (Access), and presentation (PowerPoint) programs, with strong aptitude for learning additional software.
- Must possess sharp analytical skills and strong organizational skills, have excellent communication skills and have the ability to create clear and articulate correspondence and documents.
- Independent thinking, resourcefulness, and excellent problem-solving skills are required.
- Strong analytical, creative, organizational, and interpersonal skills are required as are being hands-on, versatile, and a self-starter.
- Must be a team player comfortable working in a fast-paced organization.
- Must have the ability to teach complex concepts to users at all levels.
Working Conditions, Physical Requirements
- Office environment.
- Incumbent may be required to work at any Starling facility based on operation need, and schedule may vary.
- Travel may be required to various practice locations requiring the ability to drive, a valid driver’s license, and use of own reliable transportation.
- Physical activity will include walking, standing, and sitting.
- Physical demands may also include lifting and carrying equipment up to 30 lbs. or providing physical assistance to patients.
- Other physical requirements include speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes; vision adequate to read correspondence, computer screen, forms, etc.; and good manual dexterity.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
To apply, please e-mail a cover letter and resume to: firstname.lastname@example.org.