Value-Based Program Manager -Payor Contracting

York, PA | Professional | Tracking Code: 61134

Position Summary:

 

General Summary:
Under the general direction of the Director-Payor Contracting, and in conjunction with objectives set by the Vice President-Finance-Population Health & Payor Contracting, is responsible for all aspects of managing the relationship, the expected reimbursement, contract integrity and payor contracting operational aspects of the contractual and voluntary value based/pay for performance programs with Contracted Commercial, Medicare Advantage & Medicaid MCO Payors and appropriate WellSpan Healths internal teams. These programs and contracts place WellSpan Health and its subsidiaries at financial risk for the cost and quality of healthcare services for defined populations. To accomplish strategic goals, this position participates in a variety of high-profile financial projects.

Duties and Responsibilities:

Manages payor relationships for all WellSpan Healths contracted value based/pay for performance programs.

Develops and manages contractual and voluntary program components, assures contractual compliance, facilitates internal and external payor meetings/relationships, follows up with clinical partners to assure compliance with the programs.

Participates in the strategic improvement of value-based incentive dollars with Chief Clinical Directors, Directors of Quality, Administrative Vice Presidents, Quality & Clinical Improvement Managers, Ancillary & Hospital Leadership and Payors.

Tracks, monitors and assures the revenue integrity of value based/pay for performance programs for WellSpan Health, including but is not limited to; medical programs, behavioral health programs and ancillary programs.

Possess expertise on each value-based program and serves as the departmental value-based program expert

Maintains knowledge of industry accepted value-based programs, risk contracting/operational challenges and other value-based initiatives including but not limited to State and Federal MCO regulatory programs.

Collaborates with Quality Directors and other value base team members to routinely develop communication material and update ancillary, medical group, hospital/corporate leadership and quality councils on the status, specific successes, & opportunities of improvement of programs.

Works collaboratively with Director of Payor Contracting to assure that proposed, new and/or changed value-based programs are attainable within the organization, the contract language accurately memorializes the agreed upon terms of the contracts and appropriate WellSpan Health personnel is educated on the new or changed programs.

Acts as the liaison between the Payor and WellSpan Health

Provide financial analysis of opportunity revenue, expected or budgeted revenue & actual revenue of each program, for WellSpan Health as a whole and/or segregated by entity and program. This includes, but is not limited to the DHS and CMS routine (non-MSSP type) value-based programs

Understands the utilization and/or the variance of healthcare services and quality measures (i.e. overutilization, demand destruction, trending, risk adjustments, HEDIS/STAR Measures and the scoring of these measures) and the effect on Shared Savings/Risk and Quality Incentives.

Proficient at, or facilitates proficiency, of each payors communication links and information sharing portal

 

Required Skills

 

Minimum Education

Bachelor's Degree

Preferred Education

Master’s Degree or Comparable Graduate Work

Minimum Experience     

Third Party Payor relationships/project management skills/evaluation and data analysis/healthcare financial analytical skills

Ideal candidates have  3+ years healthcare reimbursement/revenue cycle, third party payor value-based program management experience

Supervisory/leadership experience preferred

 Must have excellent written and oral communications and interpersonal skills; computer skills. Able to work well within a team.

 

 

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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises 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.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

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.

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)