Regional Manager, Value-Based Programs - REMOTE

JOB DESCRIPTION

Job Summary

The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts.

Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs.

KNOWLEDGE/SKILLS/ABILITIES

• Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources.
• Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements.
• Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis.
• Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts.
• Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter.
• Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance.
• Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment.
• Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience

Required Experience

• 4+ years managed care experience
• Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare
• Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance
• Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding
• Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations.
• Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near term and long-term results
• Proven ability to innovate and manage complex processes across multiple functional areas
• Experience working in a highly matrixed organization, with proven ability to develop internal enterprise relations, and external strategic relationships
• Excellent presentation and communication skills

 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.