POSITION SUMMARY

As part of the TWCCH Value Based Performance team, the AVP will lead the value-based contracting, implementation, program management, and performance management for value-based contracts and programs with all credentialed payors.

The AVP Value Based Performance Program serves as a key member of the Value Based

Performance Team for assigned value-based contracts implementation, performance, and maintenance of designated value-based programs. Lead the relationships and acts as a liaison between department and internal as well as external stakeholders. This position works collaboratively with internal teams including Clinical Operations, Nursing, EMR, Billing/Rev Cycle, Quality and Safety and all TWCCH practices, as well as external teams from various national and regional payor stakeholders to achieve the Triple Aim of reducing cost, improving quality, and optimizing patient experience.

The role is key to the development and implementation of initiatives and programs to support TWCCH’s value-based strategy. This includes performing industry and regulatory control that will be used to identify, evaluate, and develop recommendations to support value-based contracting, planning, and execution.

REPORTING RELATIONSHIPS

This position will report to the Chief Financial Officer. This position does not have any direct reports.

ESSENTIAL JOB DUTIES and FUNCTIONS

While living and demonstrating our Core Values, the AVP Value Based Performance Program will:

• Build and sustain collaborative relationships with all necessary stakeholders to achieve value-based performance goals through provider-engagement and account management activities.
• Work closely with CMO and CFO to negotiate and execute contracts to transform the network from FFS contracts to value-based arrangements to include P4P, PMPM rates, bundled rates, shared risk, etc.
• Coordinate meetings with key subject matter experts (e.g., quality, billing, clinical operations) and delegate to implement new workflows, reporting requirements, and regulatory changes.
• Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership.
• Drive provider performance and engagement through delivery of routine performance scorecards, reports, and population health data.
• Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers; coordinate with interdisciplinary teams to improve outcomes (e.g., quality, clinical team, pharmacy, risk adjustment, medical economics, and IT).
• Act as primary subject matter expert for each contract
• Work cross organizationally to ensure successful implementation of provider performance programs and agreements.
• Develop, implement, manage and maintain operational systems and activities relating to value based care.
• Serve as a liaison with all levels of the organization and outside agencies.
• Manage multiple priorities and projects with competing deadlines.
• Work as lead for all required audits
• Assure provider contractual relationships and obligations are maintained in compliance with regulatory requirements and TWCCH policies and procedures.
• Allocate time to meet completion requirements.
• Serve as a coach and mentor for other positions in the department.
• Review and monitor adherence to Human Resources policies and corporate compliance procedures.
• Other duties as assigned.
• Monitor enrollment reports to identify incorrect risk/non-risk tagging.
• Identify, document, and communicate potential risk and mitigation strategies.
• Ensure contract compliance for all provider patient care initiatives and value based contracts
• Work collaboratively with the Finance team and Controller to ensure all required payments related to patient care are received and reconciled accordingly

Departmental Specific Job Responsibilities:

• Serve as a liaison with all levels of the organization and outside stakeholders.
• Drive performance on value-based contracts by driving joint payer and CC initiatives.
• Develop and manage programs to ensure alternative payment contractual obligations including care delivery, quality, financial, and legal are met.
• Partner across the enterprise to implement value-based contracts and drive value-based contract performance with cross-functional partners including but not limited to Enterprise Analytics, Strategy, Institutes, Hospitals, and third parties.
• Review contract performance against expectations and helps guide future alternative payment model direction to strengthen our value proposition, improve our competitive position, and meet goals and objectives.
• Work in a team environment and partner within Market Network Services with Contract Managers to incorporate alternative payment models into health plan agreements.
• Keep up to date on industry and patient/consumer trends within the Commercial Health Plans, Employer Health, State, and Federal insurance industry.
• Support the development of strategic summaries, positioning documents, and executive presentations that clearly and professionally communicate alternative payment model strategies for senior level audiences.
• Analyze industry trends, patient/member needs, and internal performance to deliver data-driven insights to support actionable strategic direction and prioritization.
• Manage multiple priorities and projects with competing deadlines.
• Other duties as assigned.

REQUIRED QUALIFICATION:

• Bachelor's degree in Business Administration, Healthcare Administration, Nursing or related field.
• Master’s degree preferred.
• Minimum of five years of related experience; healthcare setting preferred.
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to take appropriate action in a stressful environment.
• Demonstrated team, leadership, organizational, financial management and problem-solving skills.
• Knowledge of statistical and financial analysis, primary research and business plan development.
• Strong presentation, communication and training skills required for most positions.

**Covid-19 Vaccination Required**