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Carrot Peelers, Sales, Personality and Your Job Search
In-House
Attorney
Health Care
Litigation - Whistleblower - CFTC
Min 8 yrs required
Staff VP Payment Models, Analytics and Reporting Duties: Responsible for leading the development of payment models to support migration from volume to value based contracting. Position has end-to-end financial and analytical accountability for the company’s value-based payment models (e.g., shared savings/shared risk, bundle payment, pay for performance). As the healthcare industry continues to transform, moving away from traditional fee-for-service reimbursement, this role will be critical in the development and delivery of innovative payment models that reward and support improvements in health care quality, health outcomes, cost of care. The Staff VP, Payment Innovation will oversee multiple teams with the following set of responsibilities: Manage day-to-day operation and delivery of shared savings and risk models. This includes the development of cost, quality, and outcomes program targets; evaluation of program performance; calculation of shared savings or shared risk financial results; processing of monthly financial transactions (e.g., shared savings, care coordination PMPM payments); and maintenance of company's member attribution process. Develop analytic solutions that enable shared savings and/or risk programs (e.g., attribution, cost and quality benchmarking, cost of care analytics). Develop analytic solutions that enable bundle payment programs (e.g., service bundling). Oversee the integration of payment innovation results into the company's overall financial forecast process. Develop advanced reporting that helps provider organizations better manage quality, outcome, and utilization across value based programs. Consulting local network teams on value based contract design and execution. Oversee delivery of all analytic and financial support to local markets relating to Payment Innovation programs; this includes pay for performance, shared savings and or risk (e.g., accountable care organizations, patient centered medical homes), and bundle payment. Oversee development and maintenance of Healthcare Analytics' Payment Innovation products; this includes capabilities that cover member attribution, risk management and shared savings, accountable care analytics/reporting, and bundle payment financial modeling. Leads the development of complex risk models for all lines of business. Collaborates with Information Management, Health Care Analytics, and Provider Engagement & Contracting (PE&C) management to ensure payment innovation analytic and reporting solutions and tools support PE&C initiatives and programs. Drive centralized financial processes for provider reimbursements tied to Payment Innovation programs (financial accruals, payments, and interfaces with ASO billing, underwriting, and ledger). Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualification and Experience
The candidates should have a BA/BS in a related field; 10 years of progressive experience in managed care or integrated health services with understanding of reimbursement methods including Fee For Service (FFS), Pay for Performance (P4P), bundles, capitation and global budgets; or any combination of education and experience, which would provide an equivalent background. MBA, JD or MHA strongly preferred. Knowledge of analytical tools, statistical techniques, health care data, and financial performance assessment and analysis is required. 8 years of experience in providing analytical direction to professional exempt employees is required.
Ref: 100306.
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