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Value Based Program Administrator / Clinical Integration

Requisition ID:

21153261

Business Unit:

Hartford HealthCare Corp.

Location:

Wethersfield, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details:

Work where every moment matters.

Every day, almost 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

JOB SUMMARY:

  • Responsible for managing all aspects of current and future HHC value based contracts/programs.
  • Responsible for collaborating with Vice President of Contracting and Payer Relations and Director of Contracting and Payer Relations to develop a multi-year value based strategy that not only incorporates HHC/ICP capabilities, but also system financial implications.
  • Responsible for educating the system on value based requirements (letters of credit, stop loss, etc.) and driving consensus on value based strategy system wide.
  • Responsible for identifying problematic contract provisions and recommending alternatives.
  • Responsible for monitoring and maximizing value based revenue.
  • Responsible for managing quality and gaps in care reporting, developing dashboards to monitor and maximize quality performance, and collaborating with ICP Population Health team to provide actionable quality data to ICP practices and providers.
  • Responsible for developing tools to evaluate value based payment models holistically for the system including the revenue impact of unit cost concessions, care coordination fees, shared savings and/or losses and volume changes.

JOB RESPONSIBILITIES:

  • Manage all aspects of current and future value based contracts including developing a calendar of reports, reconciliations and payments by payer and ensuring the payers meet these deliverables.
  • Reconcile all value based payments based upon payer contracts including service level guarantee penalties.
  • Identify the drivers of underperforming contracts and recommend remediation activities to Vice President of Contracting and Payer Relations.  Collaborate with the Vice President of Contracting and Payer Relations on value based strategy.
  • Collaborate with the Director of Health Economics to maximize data acquisition from payers.
  • Develop a model to forecast value based program revenue.
  • Develop and maintain payer dashboard for value based contracts to continually assess payer performance and parity.
  • Serve as the lead for all payer value based joint operating committees (JOC).
  • Work collaboratively with Finance to develop standard processes and reporting to ensure all payments comply with contractual timeframes and all PMPM based payments tally based upon reported attributed membership.  Keep accounting of all value based revenue and expenditures.
  • Participate in ICP value based joint operating committees and serve as project manager for assigned remediation activities.
  • Develop ad hoc analysis as required.

WORKING RELATIONSHIPS:

Job Title of Individual(s) Reports To:  Director of Health Economics

Internal:  Will engage with ICP Population Health, Care Management and Managed Care Contracting teams, the CFO of HHC as well as HHC Finance teams, the CEO and COO of ICP.

External:  Will engage with payers directly.

Qualifications

REQUIREMENTS AND SPECIFICATIONS:

Minimum Requirements:

Education:

BA/BS degree in Health Care, MIS, Finance, Statistics or Mathematics.

Experience:

8+ years in hospital/physician contracting or contract analytics and 3+ years in negotiating or managing value based payment models (CMS one or two sided models (any track), bundles (CCJR), Commercial value based programs (upside, upside/downside, capitation, bundles, etc. ))

Preferred Requirements:

Education:

Master Degree in Healthcare Informatics (IT) or equivalent.

Experience:

10+ years in hospital/physician contracting or contract analytics and 5+ years in negotiating or managing value based payment models (CMS one or two sided models (any track), bundles (CCJR), Commercial value based programs (upside, upside/downside, capitation, bundles, etc. ))

Knowledge, Skills and Ability Requirements:

  • Advanced knowledge/expertise regarding current and evolving value based payment methodologies in both the Medicare and Commercial arenas
  • Experience negotiating value based contracts with payers and/or with provider systems
  • Advanced knowledge of hospital and physician contracting methodologies
  • Experience modeling contracts
  • Advanced Excel and Access required
  • Broad knowledge of health care finance and accounting
  • Strong interpersonal and communication skills essential as well as demonstrated ability to work collaboratively across functional areas
  • Superior analytic and problem solving skills
  • Customer service focus

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

 
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