Value Based Payment Operations Lead
DataStaff, Inc is seeking a Value Based Payment Operations Lead for a long-term contract opportunity with one of our direct clients located in Raleigh, NC
Position Description:
The position supports Medicaid Managed Care priorities in the QPHE unit's work focusing on quality improvement, quality measurement and evaluation, and/or population health and practice support/provider education. This position serves in a temporary or contracted role for Quality and Population Health program management, provider training and education activities, including:
- Oversee the development, implementation, and management of population health initiatives focused on value-based payments (VBP) and value-based care models.
- Serve as a subject matter expert on Medicaid policies related to value-based care and payment reform initiatives.
- Coordinate the development of provider communications (presentations, newsletters, bulletins) related to VBP
- Collaborate with internal and external stakeholders to design and implement initiatives that improve health outcomes for Medicaid populations.
- Contribute to the policy, strategic planning and design of VBP products across Health Plans/LME/MCOs.
- Review VBP reports submitted by Health Plans/LME/MCOs for accuracy and completeness.
- Perform qualitative and quantitative analysis of VBP reports submitted by Health Plans/LME/MCOs.
- Monitor and evaluate program performance against defined metrics.
- Engage with stakeholders to foster strong relationships and align efforts towards common goals.
- Lead selected special projects that require cross-functional engagement with key internal and external stakeholders.
- Serve on a variety of steering/oversight committees and workgroups.
- Build effective relationships with stakeholders to include providers, vendors, beneficiaries, advocates and associations to ensure open lines of communication.
- Effectively support the communication strategy for major process changes, policy deployments or new initiatives.
- Provide guidance and expertise to the HOP team as a Subject Matter Expert in Population Health, enhancing collective efforts to improve health outcomes and implement effective strategies.
- Provide guidance and expertise to the HOP team as a Subject Matter Expert in Population Health, enhancing collective efforts to improve health outcomes and implement effective strategies.
- Support Health Plan/LME/MCO policy updates and communication plans for notifying stakeholders of policy changes for Healthy Opportunities (HOP) and VBP body of work.
- Support provider education with a focus on HOP and VBP.
- Lead stakeholder education efforts to support advisory groups and community stakeholders.
- Work closely with contracted entities to ensure the quality of deliverables received and to oversee the process through which invoices are received and paid.
Competencies, Knowledge, Skills and Abilities Required:
- Knowledge and experience in primary care, population health models, care delivery models, care management models, and clinical program innovations
- Broad knowledge of health insurance, operations, programs, and policy
- Understanding of system design and implementation of program requirements, business processes, and technology requirements.
- Flexibility to adapt to shifting priorities and short-term deadlines
- Strong interpersonal, organization and detail orientation skills
- Experience researching and implementing federal and/or state laws and regulations.
- Excellent critical thinking, problem-solving, and project management skills.
- Ability to effectively manage day-to-day activities of complex projects
- Ability to interpret complex data, data sets and other information and to identify and communicate trends and probable outcomes
- Ability to work independently and as part of a team
- Demonstrated ability to establish and maintain strong collaborative working relationships with internal and external stakeholders.
- Demonstrated ability to communicate complex material clearly and concisely both verbally and in writing.
- Demonstrated skills in establishing and maintaining strong collaborative working relationships with internal and external stakeholders.
- Demonstrated ability to multitask with little supervision and flexibility to adapt to shifting priorities and short-term deadlines.
- Strong proficiency in Microsoft Office products including Excel, Outlook, PowerPoint, and Word.
Education and Experience Required:
Master’s degree in a discipline directly related to the population served (social work, nursing, public administration, health administration, public health, health sciences, business administration) from an appropriately accredited institution and a minimum of two years’ experience in the creation, delivery or oversight of population health programs for the population served.
OR
Bachelor’s degree as indicated above from an appropriately accredited institution in an area related to the assigned program(s) and a minimum of four years’ experience.
This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.