Director, Value-Based Programs (New Mexico Residence Required)

JOB DESCRIPTION

Job Summary

The Dir, Value-Based Programs plays a critical role in the development and implementation of business strategies, operations and vendor management related to activities in all government lines of business impacted by regulatory risk adjustment payment model.

Accountable for designing and implementing a strategy to continuously improve results of existing initiatives while also leading a continuous process of innovation to identify new initiatives which lead to the overall achievement of improved accuracy, compliancy, and completeness in risk adjustment revenue for all government lines of business. Supports the strategic direction and organization of corporate initiatives to facilitate achievement of the financial strategy and business objectives. The Director will be working within a highly matrixed organization focused on driving continuous improvements in the described areas.

KNOWLEDGE/SKILLS/ABILITIES

• Primary owner of Value-Based Programs and contracts annual plan by state by LOB development and execution. In conjunction with Regional Quality Directors, local health plans and AVP, Risk Adjustment and Value- Based Strategy, identify providers for potential VBP/VBC, assist local network and corporate network teams in reaching out to targeted providers, develop suggested contract terms (financial and quality metrics and benchmarks, assignment of reporting responsibilities and functions within contract language etc.), set annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, develop and produce reports for Regional Directors and local health plan resources to share on a regular cadence with providers to achieve goals.
• Works with AVP Risk Adjustment and VBP Strategy to leverage the needs assessment produced by that area to guide the contracting and program strategy to achieve desired goals. Works closely with the AVP to operationalize the workplan and timelines designed and supported by the AVP Risk Adjustment and VBP Strategy.
• Designs and maintains an internal dashboard of Value-Based Programs & Contracts by state by LOB for internal monitoring and senior leadership management. Ensures consistent measurement of all metrics to enable accurate comparisons and measurement of progress toward annual goals supporting financial forecasts.
• Support launching of Value-Based Programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts.
• Presents and owns VBC/VBR performance to senior leadership in monthly/quarterly leadership meetings. Designs an oversight process for internal monitoring of existing contracts within the Molina leadership team.
• Ensure Value-Based Contracting/Reporting data and reporting internally and externally are accurate
• Develops and sustains a high-performance team, dedicated to best-in-class solutions, responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.
• Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance and adherence.

JOB QUALIFICATIONS

Required Education

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

Required Experience

• 8+ years managed care experience,
• Experience leading 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 compliancy
• 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 through complex 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.