AmeriHealth Caritas Manager, Market Value Based Contracting Program in Charleston, South Carolina
Manager, Market Value Based Contracting Program
Location: Charleston, SC
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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
This role provides strategic direction for AmeriHealth Caritas transition to Accountable Care and Provider Network value based contracting (VBC) across the Plan, acting as the AmeriHealth Caritas subject matter expert for VBC for internal Plan counterparts and members of the Plan’s provider network community. The Mgr. Market Value Based Contracting Program position will report to the Director Provider Network Mgmt. Develop, implement and manage the Plan network’s value based reimbursement strategy in concert with Medical Economics and the Practice Transformation Director. In partnership with the Practice Transformation Director, Centers for Medicare and Medicaid Services (CMS) and Provider Network develop and manage the plan’s participation in the Comprehensive Primary Care Plus Model (CPC+). In partnership with Provider Network Account Executives, responsible for all assigned hospital, physician and physician extender value based contract and program development and management, formulating and implementing alternative reimbursement methodologies for various provider types that ensure the financial performance of the network. Partnering with the Plan’s Provider Network Account Executives, interacts with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care and other high level executives, facilitating, executing and communicating contract negotiations with regard to value based contract needs. Partner with internal healthcare analytics organization on development of alternative payment methodologies and strategies at a Plan level. Collaborate with internal and external support and stakeholders to integrate value-based reimbursement strategies into Plan’s provider network management framework. Ensure the provider network and internal staff achieves annual goals and objectives.Carries out Provider Network Management leadership responsibilities including:
Managing a team devoted to developing and maintaining Value Based contracts.
Manages large systems as assigned such as specific hospitals and large provider groups.
Strategic planning of hospital and physician network value based contracting development and management.
Compliance with value based contracting pricing guidelines as well as familiarity with alternative payment models framework, bundled payments, condition-specific capitation, hospital physician gainsharing, and pay for performance options.
Ensures provider value based contracting is consistent with program payment methodologies. Maintains expertise with performance-based incentive payments relative to provider practice performance of member experience measures, clinical quality measures, and utilization measures that drive total cost of care.
Maintains understanding with CPC+ Level and method of enhanced, non-visit based financial support and performance based incentive payments.
Maintains knowledge with State Medicaid fee schedules and analyzes comparable value based programs from other payors.
Ensures provider value based contracting policies are adhered to as related to standard contract language.
Ensures that non-standard value based contract elements are communicated appropriately, and approved.
Ensures capitation, RHC/FQHC reports are monitored and strategies are developed and plans are implemented to address outliers.
Manage and assists territory Account Executives with planning, implementing, and monitoring value based programs.
Manage and assists territory Account Executives in determining underperformers, and meet with them to discuss improved care.
Ensures the achievement of financial, quality, and clinical objectives through accomplishment of value based provider initiatives
Bachelor’s degree in Business or health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience.
A minimum of 5 years Managed Care Provider Contracting and Reimbursement experience, at an independent high-dollar contracting level, focusing on value based and innovative payment methodologies.
Proven financial modeling skills and the ability to communicate complex concepts at all levels. Proven influencing skills with internal and external stakeholders. 2-3 years Medicaid experience preferred. A minimum of 2 years leading Value Based contracts and programs.
Minimum 5 years of progressive business management and negotiation experience, managing projects.
People and team management experience preferred.
A valid Driver’s License and current Auto Insurance required.
EOE Minorities/Females/Protected Veterans/Disabled