Job Description
JOB DESCRIPTION
Job Summary
The Dir, Value-Based Programs (Ohio) plays a critical role in the development and implementation of business strategies, operations and provider management related to activities in all government lines of business impacted by value-based payment models.
Accountable to the design, negotiation and implementation of provider value-based initiatives in collaboration with internal stakeholders. Supports the strategic direction and organization of corporate and programmatic initiatives to facilitate achievement of the financial strategy and business objectives. The Director will be working within a highly matrixed organization focused on driving continuous improvements in the described areas.
KNOWLEDGE/SKILLS/ABILITIES
- Primary owner of Value-Based Programs and contracts by LOB including development, execution, and management. Coordination and collaboration with corporate and state leaders in areas including quality, risk adjustment, value-based strategy. Identification of providers for potential VBP/VBC, develop proposed contract terms (financial and quality metrics and benchmarks, assignment of reporting responsibilities and functions within contract language etc.), set annual targets for each VBP/VBC in conjunction with state and corporate leaders, assess and share performance of VBP/VBC programs through reporting and analysis.
- Works with corporate VP Network Management and VBP Strategy to leverage the needs assessment to guide the contracting and program strategy to achieve desired goals. Works closely with the VP Network Management to operationalize the workplan and timelines designed and supported by the Risk Adjustment and VBP Strategy.
- Designs and maintains an internal dashboard of Value-Based Programs & Contracts by LOB for internal monitoring and senior leadership management. Ensures consistent measurement of all metrics to enable accurate comparisons and measurement of progress toward annual goals supporting financial forecasts.
- Launches new Value-Based Programs to achieve goals in RFPs and financial forecasts.
- Presents and owns VBC/VBR performance to senior leadership in monthly/quarterly leadership meetings. Designs an oversight process for internal monitoring of existing contracts within the Molina leadership team.
- Ensure Value-Based Contracting/Reporting data and reporting internally and externally are accurate
- Develops and sustains a high-performance team, dedicated to best-in-class solutions, responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.
- Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance and adherence.
- Oversight and management of provider relationships associated with VBPs/VBCs.
- Leads the VBP and Provider Engagement Teams.
JOB QUALIFICATIONS
Required Education
Minimum Bachelor’s Degree in Public Health, Business, Finance or equivalent combination of education and experience
Required Experience
- 8+ years managed care experience,
- Experience leading value-based programs & contract design and implementation for marketplace, Medicaid and/or Medicare
- Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including value-based payment models, strategy, and compliancy
- Knowledge of value- based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding
- Knowledge of medical economics and financial reporting.
- Must be able to walk stakeholders through complex financial reconciliations.
- Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results
- Proven ability to innovate and manage complex processes across multiple functional areas
- Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships
- Excellent presentation and communication skills
Pay Range: $97,299 – $189,732 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.