CareOregon, Inc.
Value Based Contracting Manager page is loaded## Value Based Contracting Managerremote type:
1-2 days per week in Officelocations:
Portland Oregontime type:
Full timeposted on:
Posted Yesterdayjob requisition id:
JR100551Value Based Contracting Manager---------------------------------------------------------------This position provides leadership to the Value Based Payment (VBP) contract management team. This position leads and facilitates the management, contracting, operations, communication, reporting and data exchange in support of strategic and corporate business objectives for CareOregon’s affiliated Medicaid CCOs, Medicare, and lines of business. The position is responsible for managing operational aspects of all VBP contracts with custom terms and implements initiatives that assures CareOregon is strategically positioned to support its current and future provider networks and adheres to OHA requirements. This position works closely with other CareOregon department leadership to ensure collaboration, integration, and support of all departmental functions and externally by developing and maintaining strong relationships with providers. This position plays a critical role in leading the VBP contract management team in managing agreements with financial risk and quality improvements components, alternative payment methodologies, performs moderately complex financial analysis, and recommends contracting strategies.**Estimated Hiring Range:**$124,200.00 - $151,800.00**Bonus Target:**Bonus - SIP Target, 5% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.---------------------------------------------------------------## **Essential Responsibilities**Contracting* Implement Value Based Payment contracting initiatives that assures CareOregon is strategically positioned to support its current and future provider network and strategic partners.* Lead team who is responsible for executing contracts that ensure CareOregon is progressing toward meeting OHA requirements for Value Based Payment, among other strategically aligned contracting initiatives.* Work with Contract Specialists in the development and negotiation of contractual and financial arrangements with complex providers (e.g., hospitals, primary care and ancillary providers.* Cultivate strong business relationships with provider community.* Work collaboratively with internal departments to ensure provider operations are supported by effective, accurate and efficient business processes; reimbursements are accurately defined, communicated and configured; all provider communications are compliant, and reports are accurate, timely and meet all contractual requirements.* Oversee development and implementation of contractual terms (including but not limited to reporting and initiatives) with internal teams, including Quality, Legal, IS, among others.* Recommend modifications to policy and procedures for entry into data systems for practitioners (including reimbursement) to improve accuracy of payments to CareOregon network.* Ensure the satisfactory resolution of operational issues with provider community.* Create a unit environment that encourages professionalism and teamwork and uses progressive problem solving to meet expectation.* Ensure unit work is performed in coordination with other relevant CareOregon teams.* Perform on-going analysis of data and information looking for opportunities for improvement in department operations, including new contract management system.* Ensure all applicable Medicaid/Medicare regulations are understood, operationalized, updated and standardized in provider contract templates.* Collaborate with internal departments to ensure network adequacy and regulatory reporting obligations are met in a timely and accurate manner for Medicaid/OHA and Medicare/COA LOBs, develop contracting strategies and goals to optimize the network and enhance member access to services.
(e.g., Delivery System Network (DSN) and Network adequacy support).* Collaborate with internal departments to further develop contracts based on quality and VBP risk-based components, in line with state requirements and organizational objectives.* Lead the development and analysis for key programs, and provide recommendation based on analysis.* Collaborate with internal departments and leadership to determine appropriate changes to existing programs, participate in the design of new VBP programs and contract payment models for Medicaid and Medicare.* Recommend provider payment and network strategies to leadership and the contract team.* Serve as a lead resource to growing contract management staff in the following areas: Negotiation, financial analysis, reimbursement strategies, and alternative payment methodology process.Employee Supervision* Supervise (or manage) team and recommend team direction and goals in alignment with the organizational mission, vision, and values.* Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.* Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.* Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.* Train, supervise, motivate, and coach employees; provide support toward employee development.* Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.* Ensure team adheres to department and organizational standards, policies, and procedures.* Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).* Perform supervisory tasks in collaboration with Human Resources as needed.**Experience and/or Education**Required* Minimum 5 years’ experience in provider contracting; experience should include all aspects of contract negotiation, financial analysis, contract implementation and the actual maintenance of the contractual agreement with practitioners (e.g., incentive programs)* Minimum 2 years’ experience within a managed care organization or a health care related organization* Project management experience* Process improvement experiencePreferred* Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program## Knowledge, Skills and Abilities RequiredKnowledge* Knowledge of best practices that drive an environment of continuous improvement* Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies* Knowledge of principles of organizational change and ability to act as a change agent* Broad knowledge of the managed care industry and the ability to apply that knowledge to improve departmental performanceSkills and Abilities* Leadership skills and effectiveness, as well as the ability to design and implement constructive change* Highly effective communication, interpersonal and customer service skills* Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives* Ability to manage and cultivate strong business relationships with the provider community* Ability to provide leadership to groups of people and for the implementation of projects* Ability to organize and manage multiple tasks, complex projects and delegate as deemed appropriate* Excellent problem solving, analytical capability and decision-making skills* Ability to negotiate skillfully and to build consensus* Ability to mentor and motivate individual growth of others* Intermediate #J-18808-Ljbffr
1-2 days per week in Officelocations:
Portland Oregontime type:
Full timeposted on:
Posted Yesterdayjob requisition id:
JR100551Value Based Contracting Manager---------------------------------------------------------------This position provides leadership to the Value Based Payment (VBP) contract management team. This position leads and facilitates the management, contracting, operations, communication, reporting and data exchange in support of strategic and corporate business objectives for CareOregon’s affiliated Medicaid CCOs, Medicare, and lines of business. The position is responsible for managing operational aspects of all VBP contracts with custom terms and implements initiatives that assures CareOregon is strategically positioned to support its current and future provider networks and adheres to OHA requirements. This position works closely with other CareOregon department leadership to ensure collaboration, integration, and support of all departmental functions and externally by developing and maintaining strong relationships with providers. This position plays a critical role in leading the VBP contract management team in managing agreements with financial risk and quality improvements components, alternative payment methodologies, performs moderately complex financial analysis, and recommends contracting strategies.**Estimated Hiring Range:**$124,200.00 - $151,800.00**Bonus Target:**Bonus - SIP Target, 5% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.---------------------------------------------------------------## **Essential Responsibilities**Contracting* Implement Value Based Payment contracting initiatives that assures CareOregon is strategically positioned to support its current and future provider network and strategic partners.* Lead team who is responsible for executing contracts that ensure CareOregon is progressing toward meeting OHA requirements for Value Based Payment, among other strategically aligned contracting initiatives.* Work with Contract Specialists in the development and negotiation of contractual and financial arrangements with complex providers (e.g., hospitals, primary care and ancillary providers.* Cultivate strong business relationships with provider community.* Work collaboratively with internal departments to ensure provider operations are supported by effective, accurate and efficient business processes; reimbursements are accurately defined, communicated and configured; all provider communications are compliant, and reports are accurate, timely and meet all contractual requirements.* Oversee development and implementation of contractual terms (including but not limited to reporting and initiatives) with internal teams, including Quality, Legal, IS, among others.* Recommend modifications to policy and procedures for entry into data systems for practitioners (including reimbursement) to improve accuracy of payments to CareOregon network.* Ensure the satisfactory resolution of operational issues with provider community.* Create a unit environment that encourages professionalism and teamwork and uses progressive problem solving to meet expectation.* Ensure unit work is performed in coordination with other relevant CareOregon teams.* Perform on-going analysis of data and information looking for opportunities for improvement in department operations, including new contract management system.* Ensure all applicable Medicaid/Medicare regulations are understood, operationalized, updated and standardized in provider contract templates.* Collaborate with internal departments to ensure network adequacy and regulatory reporting obligations are met in a timely and accurate manner for Medicaid/OHA and Medicare/COA LOBs, develop contracting strategies and goals to optimize the network and enhance member access to services.
(e.g., Delivery System Network (DSN) and Network adequacy support).* Collaborate with internal departments to further develop contracts based on quality and VBP risk-based components, in line with state requirements and organizational objectives.* Lead the development and analysis for key programs, and provide recommendation based on analysis.* Collaborate with internal departments and leadership to determine appropriate changes to existing programs, participate in the design of new VBP programs and contract payment models for Medicaid and Medicare.* Recommend provider payment and network strategies to leadership and the contract team.* Serve as a lead resource to growing contract management staff in the following areas: Negotiation, financial analysis, reimbursement strategies, and alternative payment methodology process.Employee Supervision* Supervise (or manage) team and recommend team direction and goals in alignment with the organizational mission, vision, and values.* Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.* Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.* Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.* Train, supervise, motivate, and coach employees; provide support toward employee development.* Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.* Ensure team adheres to department and organizational standards, policies, and procedures.* Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).* Perform supervisory tasks in collaboration with Human Resources as needed.**Experience and/or Education**Required* Minimum 5 years’ experience in provider contracting; experience should include all aspects of contract negotiation, financial analysis, contract implementation and the actual maintenance of the contractual agreement with practitioners (e.g., incentive programs)* Minimum 2 years’ experience within a managed care organization or a health care related organization* Project management experience* Process improvement experiencePreferred* Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program## Knowledge, Skills and Abilities RequiredKnowledge* Knowledge of best practices that drive an environment of continuous improvement* Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies* Knowledge of principles of organizational change and ability to act as a change agent* Broad knowledge of the managed care industry and the ability to apply that knowledge to improve departmental performanceSkills and Abilities* Leadership skills and effectiveness, as well as the ability to design and implement constructive change* Highly effective communication, interpersonal and customer service skills* Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives* Ability to manage and cultivate strong business relationships with the provider community* Ability to provide leadership to groups of people and for the implementation of projects* Ability to organize and manage multiple tasks, complex projects and delegate as deemed appropriate* Excellent problem solving, analytical capability and decision-making skills* Ability to negotiate skillfully and to build consensus* Ability to mentor and motivate individual growth of others* Intermediate #J-18808-Ljbffr