Value-Based Care Operations Manager

Company Description

Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

This person will be part of a team contracting and managing a diversified value based care platform with over 100+ VBC contracts and over 1 million attributed lives in commercial, Medicare (Medicare Advantage & MSSP) and Medicaid lines of business across 13 states.

This person will be responsible for the implementation and management of multiple existing and new value-based care arrangements and operations of initiatives related to these value based care arrangements  in conjunction with payer contracting, business analytics and population health market leads. Troubleshoots issues across both Privia and payer partners across all lines of business. Serves as key communication liaison across payers and directs inquiries to the appropriate Privia health team. 

Essential Job Duties:

• Management of assigned book of business consisting of existing and new value-based care arrangements and operations of initiatives related to these value based care arrangements. Including Managing risks and developing opportunities in collaboration with local and national value based care teams.

• Create refine and Lead Implementation workflows, Issues/Troubleshooting and Value Based Care Reporting discussions for Quality, Cost and RA VBCs in New and Existing markets including identifying business owners and subject matter experts, identifying potential business or operational gaps and payer nuances.

• Ability to learn, understand and demonstrate analytical/quantitative thinking around the economic and clinical drivers of success in the VBC programs expressed through an understanding of the program technical designs, terms and metrics

• Develop, lead, and deliver value-based program operationalization training to internal stakeholders and external stakeholders as needed.

• Partner with cross functional and matrixed teams to drive key operational decisions, oversee implementation progress and milestones, and other project management functions.

• Serve as the escalation point for issues originating from the payer, market and/or Privia internal teams 

Project management support

• Develop and manage all aspects of projects including scope, requirements, project plans, risk identification and mitigation plans, communication, and issue resolution

• Develop project related deliverables with minimal supervision including project plans, PowerPoint presentations, status reports, meeting minutes, issue/risk logs, and meeting facilitation documents

• Assist with and present, as needed, presentations and updates of findings and make recommendations to internal and external stakeholders/leaders for assigned projects

• Monitor implementation and progress of various projects including, working closely with various internal PMG departments to efficiently communicate and execute on action plans and compliance-related initiatives

• Manage the coordination of various workgroups, committee meetings, and other best practice sharing events

Qualifications

• Typically requires a bachelor's degree and 5 to 7 years of experience. 

• 2+ years of experience in managed care operations, value-based care, and/or provider reimbursement and analytics

• Understanding of commercial, Medicare Advantage and Medicaid managed care preferred

• Experience with project management tools

• Handles basic issues and problems, and refers more complex issues to higher-level staff. 

• Possesses beginning to working knowledge of subject matter. 

• Must comply with all HIPAA rules and regulations

Interpersonal Skills & Attributes:

• Collaborative, customer-focused and able to create visible value

• Team approach to working with others, ability to perform a variety of duties within any work-day and organizational skills from planning to execution of tasks and projects.

• Extensive project management experience

• Process oriented with the ability to drive a project to completion

• Conflict management skills

• Problem solving skills with a proven track record

• Attention to detail

• Ab