Manager-Accountable / Value Based Care

York, PA | Professional | Tracking Code: 58212

Position Summary:

 

General Summary:
Under general supervision, provides support, assisting with the general management of contractual arrangements with various commercial, federal and state governmental agencies and/or their delegates for the clinical management of accountable care relationships. These programs and contracts place WellSpan Health and its subsidiaries at financial risk for the cost and quality of healthcare services for defined populations insured by these various payers. This position assures that WellSpan Population Health Services and other WellSpan entities remain in compliance with the contractual and regulatory requirements of these arrangements and provides guidance to WellSpans clinical entities to optimize WellSpans performance under these contracts. Monitors changes in federal and state laws and regulations that impacts programs designed by the Center for Medicare and Medicaid Services (CMS), state programs designed to place payment for Medicaid services in risk contracting relationships with providers, and various relationships with commercial health care insurers and administrators. Provides guidance to WellSpans clinical entities to assure that WellSpan Population Health Services and WellSpan Provider Network have the requisite information and clinical programs for the efficient delivery of healthcare services to defined populations while meeting and exceeding required clinical measures of these programs. Monitors and works to implement within WellSpan the best practices of other accountable care organizations that have similar risk contracting relationships with government agencies. Works in partnership with other leaders of WellSpan Population Health Services and WellSpan Health, including WellSpan Medical Group, independent practices in WellSpan Provider Network, WellSpans acute care hospitals and home care services, Case Management, Finance, Provider Relations, Information Technology, and Healthcare Data Analytics to assure they are aware of their responsibilities needed for success in these risk contracting relationships.

Duties and Responsibilities:

1 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.

2 Understands the various forms of utilization of health services used by beneficiaries assigned for our management and, in coordination with WellSpans Population Health Data Analytics department, generates reports of these utilization and quality of care patterns for action by WellSpans clinical entities.

3 Monitors, understands, and communicates to internal stakeholders the contractual and regulatory requirements of WellSpans various risk contracting relationships. Monitors and facilitates the progress of various clinical initiatives jointly sponsored by WellSpan and various payers designed to improve the quality and affordability of health care services.

4 Prepares and submits required reports to contracted government agencies or commercial payers to assure contractual compliance.

5 Works with the WellSpans Case Management department to implement programs that will enhance the health and improve the appropriateness of care for beneficiaries covered by our risk arrangements with governmental agencies.

6 Works with the WellSpan Population Health Services Director of Provider Relations to develop communication materials for our network of physician practices contracted through our governmental risk 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 risk arrangements with various payers.

8 In conjunction with the Population Health Data Analytics and Finance teams, develops financial reports from payer claims data that enables timely understanding and action of these financial risk relationships.

9 Prepares reports for the WellSpan Population Health Services and WellSpan Provider Network boards of directors. 



 

 

Required Skills

Minimum Education: 

Bachelor’s degree 

Preferred:

In a healthcare, healthcare policy, public health, or data analytics

Preferred Education  

Master’s Degree or comparable graduate degree

Minimum Experience           

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

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

Computer management skills including data base administration, management of contracts with IT vendors, and project management related to data management.

Excellent communications and advanced computer skills necessary for analysis and reporting of results.

General understanding of regulatory and government agencies for healthcare.

Previous experience in governmental or commercial accountable care programs is preferred

 

 


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)


Diversity & Inclusion at WellSpan

Know, Respect, Include

WellSpan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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