Virginia Premier Health Plan Manager, Value Based Purchasing in Richmond, Virginia

About Us

Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.

By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.

At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.

If this sounds like you, read on!

Overview

The position develops and grows existing value based purchasing arrangements to assist with recruitment and retention of high performing providers. Solicits participation of physician, hospitals, ancillary, and related specialty providers to establish comprehensive networks in accordance with regulatory standards.

Responsibilities

  • Work directly with senior leadership to develop, implement and deploy pay for performance, value based purchasing, provider profiling, Medicare and Medicaid reimbursement and related reimbursement payment methodologies.

  • Develop innovative reimbursement methodologies related to risk based agreements with provider networks in the region.

  • Works directly with analytic staff to identify high performing/quality centric providers in the region.

  • Ensures prompt and efficient response to provider or provider related issues with appropriate, objective documentation of concerns, recommendations of resolution, monitoring and re-evaluation.

  • Assures compliance with operation policies and production standards that result in provider network adequacy and member retention.

  • Collaborate with Director, Value Based Purchasing to set strategy for the value based purchasing unit and spearhead initiatives as needed.

  • Identifies and implements, upon approval, cost management strategies and process improvement activities.

  • Responsible for the growth and development of value based purchasing arrangements with providers, including but not limited to: Hospitals, PCPs, Specialists, LTSS, ARTS, Ancillary and Other provider types.

  • Conduct provider outreach and metrics review to evaluate success and to ensure compliance with terms of value based agreements.

  • Collaborate with the Value Based Purchasing Analytics team to model and support value based arrangements.

  • Perform other managerial duties as required.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree in Health Services, Business Administration, Public Administration or other related business field. Master’s Degree Preferred.

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Demonstrated experience with value based payment methodologies and related network development activities.

  • Proven technical and analytical skills

  • Ability to manage multiple projects while meeting deadlines and achieving business goals

  • Proven presentation and written communication skills.

WORK BACKGROUND/EXPERIENCE

  • Three (3) years network development experience

  • Proven track record with recruitmentand negotiating experience involving complex delivery systems and organizations.

  • Experience with value based purchasing programs.

  • Experience working with providers and hospital organizations.

PHYSICAL REQUIREMENTS

  • Physicalhealth sufficient to meet the ergonomic standards and demands of the position

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-5375

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.