Value-Based Reimbursement Program Manager - Remote Opportunity with CareSource

Transforming Healthcare through Innovative Reimbursement Strategies

At CareSource, we're passionate about revolutionizing the healthcare industry by fostering a culture of inclusivity, collaboration, and innovation. As a leading managed care organization, we're committed to improving the well-being of our members and communities. We're now seeking an exceptional Value-Based Reimbursement Program Manager to join our team in a fully remote capacity.

About Us

CareSource is a not-for-profit managed care organization dedicated to providing high-quality, cost-effective healthcare solutions to individuals and families. Our mission is to improve the health and well-being of our members, and we're committed to achieving this through innovative reimbursement strategies and collaborative partnerships with healthcare providers.

Job Summary

As a Value-Based Reimbursement Program Manager, you will play a critical role in managing value-based reimbursement programs within assigned markets, lines of business, and/or products. Your expertise will be instrumental in driving the success of our reimbursement initiatives, leveraging data to inform program development, and fostering collaborative relationships with healthcare providers and stakeholders.

Key Responsibilities

• Evaluate potential opportunities and understand the potential value of interventions, leveraging data to inform and develop value-based reimbursement (VBR) programs.
• Design and build standardized Alternative Payment Models (APMs) and VBR models, testing performance scenarios and generating value-based contract templates.
• Coordinate with Finance and key business areas to develop near-real-time reporting of financial, quality, and clinical performance, including building dashboards and data exports to track performance.
• Translate contract terms and Key Performance Indicators (KPIs) into code as applicable, working closely with Finance and Medical Economics teams to improve performance and reconciliation.
• Connect contract terms to predictive modeling scenarios, stratifying populations based on revenue opportunity and clinical outcomes.
• Model contract terms to estimate payments, reconciling against contract terms and performing actuarial evaluations of program outcomes to drive opportunities and contracting.
• Build and run impact models, working closely with national and market network teams and providers to improve performance and engage the right patient populations.
• Integrate with provider systems and/or data sharing as applicable, reviewing VBR reports to validate accuracy and distributing to health partners as necessary.
• Participate in identifying and implementing performance improvement initiatives to enhance the process of implementing new health partner contracts and maintenance.
• Oversee and coordinate systematic population management initiatives, managing multiple projects, collecting and analyzing data, and disseminating to appropriate departments as necessary.

Essential Qualifications

To succeed in this role, you will need:

• A Bachelor's degree in Business Administration or a related field, or equivalent work experience.
• A minimum of five (5) years of experience in value-based reimbursement design, methodologies, and/or VBR contracting, data analysis, reporting, or data support.
• Previous experience in healthcare, preferably in the managed health plan industry.
• Provider contracting or Provider relations experience is preferred.

Skills and Competencies

We're looking for a candidate with:

• Proficiency in Microsoft Office, including Word, Excel, and PowerPoint.
• Excellent written and verbal communication skills.
• A high level of analytical and problem-solving skills.
• The ability to develop, prioritize, and accomplish goals.
• Strong interpersonal skills and a high level of professionalism.
• Effective listening and critical thinking skills.
• An understanding of the healthcare payer industry.
• The ability to work independently and within a team.
• Excellent collaboration skills.
• The ability to create and maintain excellent working relationships.

Career Growth and Development

At CareSource, we're committed to fostering a culture of growth and development. As a Value-Based Reimbursement Program Manager, you will have opportunities to:

• Develop your skills and expertise in value-based reimbursement and healthcare management.
• Collaborate with cross-functional teams to drive business outcomes.
• Participate in key committees, subcommittees, and workgroups to shape organizational strategy.
• Take on additional responsibilities and contribute to the growth and success of the organization.

Work Environment and Culture

As a fully remote employee, you will enjoy the flexibility to work from anywhere. Our remote work environment is designed to foster collaboration, innovation, and productivity. We're committed to creating an inclusive and supportive culture that values diversity and promotes work-life balance.

Compensation and Benefits

We offer a competitive salary range of $81,400 - $130,200, depending on experience and qualifications. Our comprehensive benefits package includes:

• A substantial and comprehensive total rewards package.
• Opportunities for professional growth and development.
• A culture that values work-life balance and well-being.

Join Our Team!

If you're a motivated and experienced professional looking to make a difference in the healthcare industry, we want to hear from you! Apply today to join our team as a Value-Based Reimbursement Program Manager and help us shape the future of healthcare.

CareSource is an Equal Opportunity Employer, dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.