CareOregon Hiring for Director, Value Based Contracting at Portland, OR  Full Time

Job Summary

This position is responsible for leading the execution of value-based provider contracting strategy and activity across the organization. Time is focused on business group oversight, with secondary time on enterprise-wide engagement. Primary duties include technical and operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization.

Essential Responsibilities

Technical/Operational Leadership

• Directs value-based provider contracting services across all areas of the organization in support of Medicaid, Medicare, and other populations.
• Leads the execution of strategic initiatives, plans, and goals for areas of oversight in alignment with organizational vision and goals.
• Develops, operationalizes, and maintains effective alternative payment models to support delivery system transformation in partnership with internal and external teams (e.g., PCP Payment Model, Risk Agreements).
• Ensures Network and VBP strategies are supported by evidence base and best practices that relate to the models being developed; integrates findings into the design of methodologies.
• Works with internal leaders in the development, implementation, and maintenance of quality payment strategies and risk models within regional networks.
• Advises leadership on ways to improve CareOregon’s strategic positioning to support its current and future provider network and strategic partners; collaborates with leadership in the development and negotiation of complex contractual and financial arrangements with complex providers (e.g., hospitals, primary care physicians and ancillary providers).
• Develops and maintains process to evaluate financial and network impact of alternative payment methodologies and continually review and adjust strategies accordingly in conjunction with actuarial staff.
• Assists in the development, implementation and maintenance of analytical plans and evaluation plans of developed models in quality of care, health care utilization, and cost trends as necessary for the program.
• Oversees and ensures the timely completion of value-based payment regulatory reporting.
• Develops or ensures internal systems and measures are in place to support effective, efficient, and compliant operations.
• Provide oversight of the development and maintenance of policies, procedures, structures and training to support the staff and department into the future.
• May serve as a sponsor or chair for key projects and initiatives.
• Effectively articulate and disseminate models and innovation results using a variety of communication channels to include written reports, graphic data display, PowerPoint presentations, speaking engagements, and manuscript publications.

Strategic/Operational Planning

• Leads the oversight of alternative value-based payment strategies in partnership with NCS that supports delivery system transformation across multiple mechanisms of payment (payment methodology, incentive payments and shared savings, grant programs, etc.).
• Develops, operationalizes, and maintains a Network Risk Strategy that supports the Network, Members and CareOregon’s needs and capitalizes on the existing Risk Model work, regional and national initiatives.
• Participates in the development of vision, goals, and strategic plans across business teams and regions.
• Develops short- and long-term plans and policies; oversees the development and execution of standard operating procedures.
• Provides input into strategic plans of the organization.
• Maintains a business unit and member view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

• Recommends budgets in alignment with short- and long-term plans.
• Manages resources to ensure priorities are accomplished.
• Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.

Relationship Management

• Builds and ensures effective relationships across internal teams, line of business customers/stakeholders, and external organizations for current or future integration.
• Partners with internal leaders and managers in identifying improvement plans and processes.
• Works closely with the internal leaders to ensure that agreements, relationships, reporting and programs are properly supported for our members and our network partners.
• Cultivates strong business relationships with the provider community.
• Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.
• Leads effective communication system for work group(s), ensuring a collaborative culture.

Employee Supervision

• Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
• Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
• Identifies department priorities; ensures employees have information and resources to meet job expectations.
• Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
• Manages, coaches, motivates, and guides employees; promotes employee development.
• Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
• Ensures team adheres to department and organizational standards, policies, and procedures.
• Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
• Performs supervisory tasks in collaboration with Human Resources as needed.

Experience and/or Education

Required

• Minimum 10 years’ progressively responsible experience in contracting and/or provider network systems

Preferred

• Minimum 4 years’ experience in a supervisory position
• Management experience in a managed care organization or practice setting
• Value based contracting experience
• Provider relations experience

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of managed care and the Oregon Health Plan
• Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies
• Knowledge of complex and alternative reimbursement arrangements
• Knowledge of federal Medicare regulations and state Medicaid rules (OARs)
• Knowledge of claims administration and ability to implement contract reimbursement terms
• Knowledge of physician group, hospital, and facility operations
• Thorough knowledge of principles and statistical methodologies for program assessment and evaluation

Skills and Abilities

• Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), and ability to perform rate calculations
• Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
• Demonstrated leadership effectiveness and ability to design and implement constructive change
• Strong people management skills, including the ability to coach and motivate teams
• Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives.
• Excellent critical thinking, analytical and problem-solving skills
• Ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
• Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
• Highly skilled in resource management
• Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
• Ability to influence and build consensus

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

#Li-Hybrid

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.