Value Based Care Performance Manager
Full Time
Phoenix, AZ 85021
Posted
Job description
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Manage relationships and performance with partner organizations for value-based and population health programs that support the corporate vision for value-based care (VBC). 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 performance plans and outcomes for VBC and population health programs.
REQUIRED QUALIFICATIONS
Required Work Experience
- 8 years of experience in a healthcare field
- 5 years of experience working on Value Based Programs
Required Education
- High School Diploma or GED in general field of study
Required Licenses
- N/A
Required Certifications
- N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
- Experience working with Medicare STARS, Risk Adjustment, HEDIS or other quality initiative
- Bachelor’s or Masters Degree in healthcare or business-related field of study (Applies to All Levels)
- N/A
- Certification in one or more healthcare quality and/or accreditation functions (e.g. NCQA Content Expert)
ESSENTIAL job functions AND RESPONSIBILITIES
LEVEL 1 Functions with general support from Management
- Collaborate with contracted value based care program participants to achieve program goals.
- Be key contact for the plan for VBC program participants to ensure they receive concierge level of service for performance and education needs.
- Coordinate and 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, but not limited to: Data Analytics, Integrated Care Management, Provider Partnerships, Medical Directors, Internal Audit and Actuarial.
- Collaborate with VBC 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.
- Manage VBC data exchange and monitor performance of VBC and population health data to ensure partner performance success
Level 3
Functions independently with limited oversight from Management
- Mentor and support new VBC Program Manager staff.
- Participate in evaluation of program’s effectiveness both from an internal Plan and external provider practice perspective as determined by management
- Identify and implement opportunities for collaboration with vendors to improve the program outcomes.
- Provide guidance to partners and VBC Program Managers to ensure improved outcomes and accountability on performance on contracts
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.
Our Commitment
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
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