Job Description
Director, Value-Based Programs
The Director, Value-Based Programs supports the Washington health plan in the development of VBC strategy and implementation related to Quality and Risk Adjustment. This position shall serve as the subject matter expert in Quality/HEDIS measures, Data Management & Reporting, Risk Adjustment and evaluating the quality components of value-based reimbursement models. The Director plays a critical role in the development and implementation of business strategies, operations and vendor management related to activities in all government lines of business impacted by regulatory risk adjustment payment model. Accountable for designing and implementing a strategy to continuously improve results of existing initiatives while also leading a continuous process of innovation to identify new initiatives which lead to the overall achievement of improved accuracy, compliancy, and completeness in risk adjustment revenue for all government lines of business. Supports the strategic direction and organization of corporate and local 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
Under leadership of the AVP, Health Plan Quality Improvement & Risk Adjustment, the Director develops and implements the VBC strategy related to Quality and Risk Adjustment and is responsible to manage day-to-day work related to VBC contracts and provider relationships across the network – address issues, develop and provide education, facilitate meeting to achieve established goals related to Quality and Risk Adjustment.
- In conjunction with the AVP, Quality & Risk Adjustment, local health plan and national teams, identify providers for potential VBP/VBC, assist local network and corporate network teams in reaching out to targeted providers, develop suggested 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 and oversee the development of reports to share on a regular cadence with providers to achieve goals.
- Works closely with the AVP, Quality & Risk Adjustment, Finance, Provider Network, EIM, Quality & Risk adjustment leaders and other stakeholders to operationalize the workplan and timelines.
- Collaborates with national Risk Adjustment and VBP Strategy teams to leverage the needs assessment produced by that area to guide the health plan program strategy to achieve desired goals.
- In partnership with Provider Network & Contracting, interact with providers and facilitate the negotiation & implementation of quality measures in value-based care contracts.
- Lead and manage process of determining Quality measures performance and final settlement leading to payout.
- Supports expanding and developing Specialty VBC models such as Maternity, Behavioral Health, and Health Equity and Practice Transformation.
- 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.
- Support launching new Value-Based Programs across all LOBs 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.
- Supports all provider facing quality improvement interventions.
Required Education
Minimum Bachelor’s Degree in Public Health, Business, Finance or equivalent combination of education and experience
Required Experience/Knowledge, Skills & Abilities
- 8+ years managed care experience,
- Experience leading value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare
- Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, 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 – $179,684 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.
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