Value Based Program Manager-experience in Value Based Programs required

Manage relationships with provider organizations for new value based programs that support the corporate vision for value-based programs (VBP). Coordinate implementation of programs with operational, financial and clinical leadership. Build a collaborative framework to facilitate exchange of ideas and be an advocate for the operations component of all VBPs developed. Responsible for all implementation plans developed for rolling out new programs and changes to existing programs.

REQUIRED QUALIFICATIONS

• 5 years of experience in a healthcare field

• 2 years of experience working on Value Based Programs

Required Education

• Bachelors Degree in healthcare or business-related field of study (Applies to All Levels)

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

• Experience working with Medicare STARS, Risk Adjustment, HEDIS or other quality initiative

Preferred Education

• N/A

Preferred Licenses

• Registered Nurse with active unrestricted Arizona license

Preferred Certifications

• Certification in one or more healthcare quality and/or accreditation functions (e.g. NCQA Content Expert)

• Collaborate with contracted value based care program participants to achieve program goals.
• Be single point of contact for the plan for VBC program participants to ensure they receive concierge level of service.
• Facilitate meetings between the plan and VBC program participants, including sessions with program leads, monthly joint operating committee meetings, and clinical reviews.
• Review and communicate results of reports developing a complete understanding of the tools and criteria used to generate the reporting.
• Ensure VBC program participant provides required documentation to support plan quality initiatives including STARS, Risk Adjustment, HEDIS and well as others.
• Provide education and training to program participants regarding criteria for compliance with measures
• Collaborate with segment leads to ensure clear understanding of their goals and objectives with the VBC relationship.
• Maintain effective working relationships with multiple areas within the organization.

LEVEL 2 Functions with limited support from Management

• Implement new VBC relationships, using framework to ensure deliverables on both sides are met.
• Use process improvement tools to identify areas of improvement with the VBC relationship.
• Interact with internal departments within the company including Data Analytics, Integrated Care Management, Provider Partnerships, Medical Directors, Internal Audit and Actuarial.
• Collaborate with Population Health Management team and provide feedback on VBC performance specific to individual program participants and program as a whole
• Support internal departments with coordinating requests for integration into VBC including Risk Adjustment, HEDIS data collection and other initiatives as identified.
• Develop a playbook for implementing new programs with key factors and timelines that highlight key milestones and risks.
• Develop wide knowledge base of VBC capabilities and ways the plan can support positive outcomes from the program.
• Work with vendors to implement pilots or programs that support the corporate vision for Value Based Programs including providing guidance on current program requirements and future expected state.

Level 3 Functions independently with limited oversight from Management

• Mentor and support new VBC Program Manager staff.
• Participate in evaluation of programs effectiveness both from an internal Plan and external provider practice perspective.
• Identify and implement opportunities for collaboration with vendors to improve the program outcomes.

ALL Levels

• Each progressive level includes the ability to perform the essential functions of any lower levels.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• In state travel is required for onsite visits to practices and provider organizations; After hours sessions with practices are also required.
• Perform all other duties as assigned.

Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. Thats the kind of satisfaction youll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross BlueShield of Arizona