York, PA | Professional | Tracking Code: 79776

Director of Value Based Care Programs

Ed Pritchard
Ed Pritchard
Sr. Talent Acquisition Consultant
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May 18 In-Person Hiring Events
10:00 a.m. – 2:00 p.m.
WellSpan Ephrata Community Hospital, Ephrata / WellSpan Surgery and Rehabilitation Hospital, York / WellSpan Waynesboro Hospital, Waynesboro
Positions: Certified Sterile Processing Technicians, Food Services, Housekeeping, LPN, Medical Assistant, Nursing, Nursing Support, Pharmacy, Allied Health: Lab Services, Respiratory, Imaging, Surgical Technologist, Home Health RN, Home Health LPN
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May 25 In-Person Hiring Events
10:00 a.m. – 2:00 p.m.
WellSpan Medical Group, York
Positions: Dental Assistant, Dental Hygienist, Medical Assistant, LPN, Patient Service Specialists
MAY
2022
In-Person Hiring Events -
Various Locations and Dates

General Summary:

 

This position provides team-based direction for value-based care programs including development of new programs, management of program application and onboarding processes, oversight of program compliance and regulatory requirements, and ongoing development and deployment of performance maximization strategies. This position maintains niche expertise in commercial and/or governmental payment models to optimize WellSpan’s performance under value-based care programs, requiring strong partnership with clinical, operational, and administrative entities and WPN. Monitors changes in federal and state laws and regulations that impact programs designed by the Centers for Medicare and Medicaid Services (CMS), state Medicaid programs, and relationships with commercial payors and administrators. 

 

Duties and Responsibilities:

The following are essential job accountabilities:

 

  1. Develops, deploys, and facilitates the progress of various clinical and operational initiatives designed to improve quality, improve affordability, and reduce medically unnecessary, avoidable utilization of health care services, improve network keepage, improve accuracy of coding and documentation, and manage program attribution among populations in value-based care programs.
  2.   Monitors, maintains subject matter expertise, and directs implementation of contractual and regulatory requirements of WellSpan’s various value-based care contracting relationships. Prepares, coordinates, and submits required reports to contracted government agencies and/or commercial payers to assure contractual compliance.
  3.   Provides general support for enterprise-wide strategies linked to WellSpan’s journey to value.
  4.   Maintains expertise into the various forms of utilization of health services used by attributed populations assigned for our management and, in coordination with WellSpan’s Data Analytics Center of Excellence, develops and deploys reports of these utilization and quality of care patterns for action by WellSpan’s and WPN’s clinical and operational entities.
  5.   Works with the WellSpan’s Case Management department to implement programs that will enhance the health and improve the appropriateness of care for patients covered by our risk arrangements with governmental agencies.
  6.   Works collaboratively with the WellSpan Population Health Services Director of Provider Relations and Director of WPN Development to develop actionable engagement materials for our network of physician practices contracted through our value base care arrangements.
  7.   Works with the WellSpan Managed Care Medical Director to develop programs designed to influence the appropriate use of pharmaceuticals used by beneficiaries covered by our value-based care risk arrangements with various payers.
  8.   In conjunction with the Analytics Center of Excellence and Finance teams, develops financial reports from payor claims data that enables timely understanding and action of these financial risk relationships.
  9.   Prepares reports for the WellSpan Population Health Services board of directors.
  10. Maintains knowledge of healthcare industry trends related to quality management, conformance to regulatory requirements, and linkage of compensation to performance, public reporting of clinical performance data and targeted areas for health system improvement.

 

Qualifications:

 

Bachelor’s degree in a healthcare, healthcare policy, public health, public policy, or data analytics

Master’s Degree or comparable graduate degree

1 - 3 years’ experience in healthcare value-based program management/evaluation and data analysis.

3 – 5 years’ experience in healthcare value-based program management/evaluation and data analysis; proficiency in use of Epic within population health functions; understanding of regulatory environment as it relates to value based programs.

Previous experience in governmental or commercial value-based care programs.

Understanding of the population health and accountable care contracting relationships between payors and providers. Solid understanding of patterns of chronic disease and measurements of performance related to the best management of these conditions.

 

 

 


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Join our team of 20,000 strong working as one. Teamwork, collaboration, partnership—WellSpan Health is an integrated system designed to work as one to build healthier, stronger communities throughout central Pennsylvania and northern Maryland. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

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