Director of Value-Based Contracting
This position is responsible for the day-to-day operations/management of Amida Care’s key provider groups (including all sponsors) and entities with a value based contract Quality Incentive Program. The position is responsible for oversight, management and reporting for all providers participating in the Quality Incentive Program. Develops value-based contracting metrics, contract monitoring procedures and ensures achievement of contract administration/metrics objectives. Negotiates contracts and supports implementation and ongoing maintenance of all Amida Care’s contracts, shared savings and future risk contracts including base contracts and value based contracts. Works closely with Sr. Management team and develops and oversees programs with key provider groups.
This role is accountable for driving success in value-based care for the organization. This position develops, contracts, maintains, and enhances relationships with providers whom are part of a Value Based relationship and/or Sponsor site agreement with the plan.
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.
• Serve as plan liaison for physicians’/physician groups related to a Value Based arrangement or part of a key Sponsor Site of the plan. Will be main point of contact for all plan-related issues including contracting, billing and reimbursement.
• Responsibility for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician.
• Identify requirements for selecting Value-Based partners and manage day-to-day oversight of quality incentive programs.
• Analyze potential contracting arrangements and assist with development of contract terms.
• Implement value-based contracts including Quality Incentive programs, shared savings and risk contracts.
• Develop and oversee reporting requirements and run daily, weekly, and/or monthly reports as needed to share with provider groups. Present results to Value-Based partners and ensure positive relations with Value-Based Partners.
• Maintain value-based contracts with Sponsor Site Providers, Federally Qualified Health Centers (FQHCs)/Community Health Centers, and hospital-based Faculty Practice groups on behalf of Amida Care.
• Act as liaison and manage the relationship between State and Plan for submission of quarterly reports
• Develop new, effective supporting tools to drive medical cost reductions and support value-based initiatives.
• Provides face to face provider support for successful value based arrangements; lead JOC (Joint Operating Committee) meetings.
• Acts as the primary partner with providers to ensure success in current contracts and leading initiatives for providers to take on greater risk in their value based contracts or in new value based programs.
• Drives medical and behavioral health integration initiatives.
• Analyzes financial performance quality metrics and reports to providers on the impact to performance.
MINIMUM JOB REQUIREMENTS
• Bachelor’s Degree in health care administration or business; or equivalent combination of education and relevant work experience.
• Minimum of five (5) years’ experience in health care; including at least two (2) years in provider/payor contracting with focus on value-based contracting.
• Demonstrated experience in developing value-based contracts, fee arrangements and other contract terms, running reports, and managing data bases to support quality metrics.
• Strong knowledge of medical terminology for value-based contracting.
• Demonstrated experience in developing and recommending potential solutions to contract issues.
• Strong knowledge of Microsoft Office (Word, Excel, Access).
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.
Amida Care is a Diversity, Equity, and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.
*Amida Care requires that all employees be fully vaccinated and must show proof of vaccination status.Position Description »