Sr. Manager, Value-Based Care Operations

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The Sr. Manager, Value-Based Care Operations will be part of a team 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 14 states.

The Sr. Manager, Value-Based Care Operations will be responsible for the implementation and management of existing and new value-based care arrangements and operations of initiatives related to those 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 risk adjustment for value-based care contracts in both new and existing markets

• Identifying and building relationships with business owners and subject matter experts, to solve business or operational gaps with our payer partners.

• 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 actions plans in conjunction with internal and external stakeholders across markets driving our performance in value-based contracts

• 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.

• Develop and maintain strategic relationships with payers at a national level

• 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

• Bachelors Degree or equivalent relevant experience 

• 5+ 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 creat