Director Of Payer Relations And Vbc Ops

Career opportunities at VillageMD and our operating companies
We're a physician-led, patient-centric network committed to simplifying the complexities of health care and bringing a more connected kind of care.
And now we're proud to say we're part of the VillageMD family.
VillageMD, through its operating companies, provides high-quality, accessible health care services for individuals and communities across the United States, with primary, multispecialty, and urgent care providers serving patients in traditional practice settings, in patients' homes and online appointments.
Committed to serving all patients and working with all payers, VillageMD consistently innovates value-based care, bringing integrated applications, population insights and staffing expertise to its owned and affiliated practices, ensuring high-quality care, better patient outcomes and a reduction in the total cost of care. Through Village Medical, Village Medical at Home, Summit Health, CityMD, Starling Physicians, Westmed, and other practices, VillageMD serves millions of patients throughout their lives, wherever and whenever they need care. Its dedicated workforce of more than 20,000 operates from 770 practice locations and 26 markets.
Why become a Villager?
When you work at VillageMD, or a VillageMD operating company, you are part of a compassionate community of people who work hard every day to make health care better for all. What makes us different is our village of supportive and inspiring peers who want a meaningful career with impact. The work we do is changing the lives of our patients, our communities, and each other. Together, we are creating better outcomes for all.
We're reimagining health care with a primary care-led, value-based care model. Here, you will be part of a team delivering the care we want to see in the world. It is what drives us to knock down old barriers in health care because every patient, every person and every community deserves better care. Here, you will be at the center of our mission. Your voice will be heard, and you will feel empowered to do what's best and right for our patients, communities, and each other. To learn more about VillageMD visit our corporate site VillageMD.com.
Job Description
Position Summary:
As part of a multi-disciplinary team, the Director will lead the implementation of strategies that drive success in value-based contracts. She/he will direct a team that serves as the experts on VBC contracts and drive success in VBC by collaborating across the organization on the design, monitoring and continuous improvement of population health management processes. The Director will report to the Chief Population Health Officer.
The Director will ensure that the team has full understanding of all the VBC contracts and needed strategies for success. This includes government programs and Alternative payment models such as the Medicare Shared Savings program. The team will be responsible for translating the contracts into requirements and tactics for clinical and operational team. They will maintain summary documents outlining metrics, benchmarks, care management requirements, financial terms, incentives, and other components of the VBC contracts and serve as the subject matter experts on this content.
The Director will plan and support implementation of performance improvement activities in support of Population Health/Value Based Care priorities based on her/his knowledge of the contracts. She/he is responsible for creating and refining clinical, business and organizational requirements, and will work closely with internal team members, stakeholders, and collaborators to ensure that projects are conducted in a timely manner to achieve goals within defined budgets and work plans.
The Director and her/his team will the liaisons between clinical and Health Plan teams to help facilitate decisions and actions. In addition, they will coordinate and schedule clinical meetings and Joint Operating Committee meetings with payers as appropriate. They will track all issues and discrepancies in data and work with payers towards adjudication. This team will also drive discussions with payers on clinical and performance disputes that arise.
The Director will oversee the bidirectional communications with payers, including holding payers accountable for delivering all contractually required reports and analytics in a timely manner. In addition, the director will work with payers to develop meaningful and actionable reports that support successful population health management. This team will also ensure that our group successfully reports our performance back to payers to meet our contractual requirements and demonstrate the high quality of care delivered.
The VBC Ops team will collaborate to integrate clinical analytic, ancillary and operations capabilities to manage patient populations against improvements in the 'Quadruple Aim' of healthcare: better outcomes, lower cost and an improved patient and clinician experience.
Essential Job functions:
The essential functions of the position include:

• Work in a hybrid environment. In addition to working remotely, this role will require in-person meetings, visits to providers, presentations to departments, and attending Joint Operating Committee meetings. In the future it is possible that the director and the team will have to work full-time on-site.
• Lead a team of highly motivated individual that translates the VBC contractual requirements into clinical processes and strategies. And direct the team to ensure strong bidirectional communication of the same.
• Understand assigned value-based contracts and serve as the subject matter expert on the program requirements, program reporting and data exchange, tracking of performance, and development of strategies to achieve success in the contracts.
• Direct daily activities to design and develop approaches to value-based care projects and/or program strategies that ensure the strategic direction is in line with Summit Health's clinical and business objectives
• Cultivate and maintain relationships across various internal departments including Quality, Analytics, Pharmacy, Coding, Primary Care, Care Management, Finance, IT, Marketing, Constant Care and Training to ensure value-based care clinical program participation and collaboration
• Provide adjunct analyses of the business and/or clinical processes related to value-based care initiatives to inform the project plans and assist the leadership with information to make decisions to move the project to successful implementation.
• Deploy and track of new clinical population health management initiatives.
• Measure practice-level performance across operational and utilization metrics, and identify improvement opportunities to drive strong performance under value-based contracts.
• Act as the liaison between Health Plans and the group in various areas, inclusive of general contracting requirements, clinical data exchange, quality, risk adjustment, clinical and care management collaborations, and other aspects of VBC.
• Own the process of monitoring clinical performance in value-based contracts across multiple Health Plans. Summarize clinical performance findings and trends with recommendations for business decisions.
• Develop and maintain current documentation for the value-based programs with various Health Plan partners (policies, program descriptions, business/action plans, etc.)
• Develop and deliver presentations for varying levels of staff up to and including C-suite executives with the end goal of securing buy-in on strategy or operational decisions related to clinical population health initiatives
• Understand the clinical and financial aspects of value-based care programs and be comfortable working with all levels of management and staff
• Collaborate across cross-functional teams to develop policies and procedures to support clinical systems, standards of practice, and evidence-based practices
• Serves as an internal resource for expedited problem identification and resolution, provision of project-specific updates, and team interactions and deadlines
• Provides daily support and subject matter expertise on value-based care and identifies areas of opportunity for continuous improvement including on-going education and resources as needed
• Direct her/his team to continuously update various portals and clinical dashboards to accurately reflect current provider population, demographics and other key performance indicators as determined by Summit Health or Health Plan partners
• Collaborate with and provide subject matter expertise to the Clinical Analytics Team on the development of actionable reports that will maximize the VBC program outcomes on all related program metrics.
• Collaborate with the Training Team on educational materials that will support staff and provider training related to VBC. Present educational sessions to various audiences to enhance knowledge of VBC concepts such as attribution, quality measures, and care management processes.
• Collaborate with Aftercare/Call Center Teams on patient outreach, engagement and scheduling initiatives that are critical to population health management workflows, including prioritization, tracking and monitoring, and providing subject matter expertise.
• Monitor and evaluate value-based care program-related communications from CMS and Health Plans, and assess for relevance and impact on Summit Health
• Attend webinars and in-person meetings to stay involved in changes in value-based care programs
• Keep abreast of government reforms and their impact on our various risk programs
• Maintains a working knowledge of population health trends in the context of Payer strategies, legislation, industry leaders, and health care practices and incorporates best practices into the strategic vision of Summit Health.
• Drive an optimal patient experience through Summit Health processes and services
• Implements and executes programs for onboarding new value-based programs - including but not limited to developing committee and operational structures and accountabilities and ensuring practice readiness for accountable care requirements

General Job functions:

• Strong leadership skills to both motivate and engage team members, as well as held them accountable l to a high level of performance.
• Highly motivated, professional, and ethical.
• Dive the mission, vision and values of Summit Health and incorporate these into leadership behaviors, practices, and decisions.
• Participate on committees and in special projects
• Perform other related duties as assigned or requested.
• Maintain the highest level of customer service and satisfaction for all areas of responsibility.
• Other job duties as required.

Education:

• Master's Degree Required. Relevant health care or business field degree preferred

Experience:

• 7+ years of work experience in a healthcare setting preferably with a complex enterprise health care system or large medical group
• 2+ years in leadership positions, ideally related to VBC and/or Population Health Management
• Project Management experience necessary (PMP Certificate not required)

Required Licensure / Certification / Registration:

• Valid Driver's License

Specialized Skills & Knowledge

• Must have a comprehensive knowledge or be resourceful in collecting the information needed around the Affordable Care Act (ACA), Medicare Shared Savings Programs, CMS programs, accountable care organizations, value-based contracting, population health management, clinical integration including but not limited to Federal/State regulations, programs, implementation and operations.
• Knowledge of Government and Private Payer ACO Programs highly preferred.
• Honesty, integrity and caring with the ability to inspire and motivate others to promote the group's mission, vision, goals, and values.
• Strong leadership skills and judgement to effectively manage teams as well as multiple tasks and priorities. Must be able to work concurrently and collaboratively on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles, and with changing deadlines and competing priorities
• Strategic planning, management and execution skills and the demonstrated ability to be successful with large-scale project implementation.
• Superior verbal and written communication skills (in English) to present advisory, persuasive, and authoritative recommendations to all levels.
• Ability to interface with and build robust relationships with all levels of an organization's leadership, key stakeholders, and decision makers.
• Ability to support a change management and process improvement work environment. Seeks innovative ways to deliver higher value programs and services more efficiently and effectively.
• Ability to define program, process and business objective and scope. Demonstrated proficiency and expertise to identify, evaluate and articulate operational opportunities and risks, business needs and gaps, and understand overall customer and stakeholders' interest.
• Advanced analytics, evaluative and problem-solving skills to serve in an advisory role in inspiring and initiating new ideas, determining strategies in the absence of guidelines, fostering innovative approaches to situations/processes/issues.
• High proficiency in Microsoft Office applications required, including but not limited to Excel, PowerPoint, Teams, Outlook, Word.

Physical and Mental Requirements and Working Conditions

• Must be able to adapt to frequently changing work priorities and be able to prioritize and balance the requirements of working with multiple teams and projects.
• Must be able to travel extensively to the various sites (inside and outside of New Jersey)
• Ability to perform duties with time limitations with a high degree of accuracy preferred

Total Rewards at VillageMD
Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD's benefit platform includes Medical, Dental, Life, Di...