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Director, Value Based Payment Initiatives

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Director, Value Based Payment Initiatives

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You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: The Director of Value Based Payment Initiatives (VBP) will oversee the design, implementation, ongoing operation and evaluation of the organization’s VBP initiatives. The individual is responsible for the success of the organization’s VBP program. The VBP Program success is defined as one that is consistent with the New York State Roadmap For Medicaid Payment Reform (the Road Map), incorporates incentives that encourage providers to improve the quality and effectiveness of the services they provide while simultaneously reducing their unnecessary use of delivery system resources. The VPB program should not disrupt the organization’s preexisting relationships with any provider partners. The VBP program should result in aggregate quality and financial outcomes that are consistent with the organization’s objectives.

Provides programmatic support to Contract Management during all VBP contract negotiations and renegotiations. Manages, through the dedicated VBP staff, all provider interactions related to the ongoing operation of each VBP arrangement. Oversight of the analytics provided by Fidelis to its VBP provider partners designed to describe each provider contracting entity’s performance and opportunities for improvement in the context of its VBP contracting arrangement. Continuous monitoring, in conjunction with Finance and QHCM of the impact VBP results are having on the organization’s fiscal and quality objectives. Program Growth: Grow the organization’s VBP program consistent with the objectives described in the Road Map and in accordance with the organization’s objectives. Oversight: Reports into the VP of Value Based Initiatives and is responsible for the leadership and management of the dedicated VPB team, who will be directly interacting with those provider contracting entities that have entered into VBP arrangement and will be responsible for carrying out the other activities required to support the organization’s VBP initiatives. Regulatory/ Compliance: Assure compliance of VBP payment policies with state, federal, legal and regulatory requirements and consistent with the intent of state and CMS protocols as defined in the RoadMap.

Education/Experience: BA/BS – Bachelors Degree Required MBA/MHA/MPH Preferred. Managed Care/Value Based Contracting: 5+ years of progressive payor managed care experience including at least 3 years leading VBP initiatives for a payor managed care organization. Prior experience with, design of successful VBP arrangements, oversight of VBP implementations, and oversight of the systems and processes used to monitor each VBP provider group’s performance. Strong understanding of quality measures, technical specifications, and data related to quality (HEDIS/QARR; PQI,PDI; PPV, PPR, PPAs as examples). Experience with ACO models and NYS DSRIP is preferred. Customer Service: Effectively communicate with all levels of management, internal and external customers. Ability to work well as a member of a team or alone. Effective Business Writing Skills: Communicate with technical and business constituencies effectively. Experience in writing business specifications and requirements. Effective financial modeling skills and proficiency with Excel in modeling out complex VBP arrangements.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Pay Range: $111,600.00 - $206,400.00 per year

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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