Analyst, Value Based Payment Initiatives

Centene•Rosedale, NY

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyst of Value Based Payment initiatives will assist in the execution of the organizations Value Based Payment contracting strategies (VBP). This position will be responsible for working with the VBP AVP, VBP Managers and other cross functional teams in the management of multiple VBP relationships including Provider Groups (IPAs) and the other contracting entities like ACOs and potentially DSRIP PPSs. Work collaboratively with Contract Management to design and refine, the VBP contract negotiated with each assigned VBP Provider Group partnership. Accurately and effectively communicate the status of each VBP relationship to the VBP team and other cross-functional leads. Recommend reporting enhancements based on VBP partner feedback and needs identified through regular use of the existing reporting tools. Appropriately prioritize and escalate VBP issues to the AVP and Managers of VBP Initiatives. Work with the Manager / Lead of each VBP partner to develop strategies and action plans designed to eliminate any aberrant utilization and or quality of care patterns that will prevent the VBP partner from having a successful outcome through its Fidelis VBP relationship. Assist internal and external VBP meetings (clinical, IT, legal, etc ) in order to resolve any issues related to the operation of those VBP relationships that have been assigned. Assist in tactical execution of the business plan objectives to drive success of each VBP relationship. Assist in building and maintaining relationships with key individuals at assigned PPS organization and their related VBP contracting entities. Act as a subject matter expert on all VBP related matters. Assist in implementation for VBP assigned relationships including third party vendors. Provide daily assistance in the management of VBP activities, including data analysis, problem resolution and other activities to assist in the facilitation of a successful relationship with assigned Provider Group Partners. Performs other duties as assigned. Complies with all policies and standards. The VBP Strategy: Is consistent with the New York State Roadmap For Medicaid Payment Reform (the Road Map). Incorporates incentives that encourage providers to improve the quality and effectiveness of the services they provide while simultaneously reducing their unnecessary use of delivery system resources. Does not disrupt the organization's preexisting relationships with any provider partners. Results in aggregate quality and financial outcomes that are consistent with the organization's objectives.

Requirements

BA/BS - Bachelors Degree Required.
Minimum of 1-3 years of relevant healthcare operation or policy experience.
Communicate with technical and business constituencies effectively.
Experience in writing business specifications and requirements.
Knowledge of Financial, Asset Management, and Expense modules.

Nice To Haves

MBA/MHA/MPH Preferred.
Graduate education in health care administration or other related areas preferred.

Responsibilities

Assist in the execution of the organizations Value Based Payment contracting strategies (VBP).
Work with the VBP AVP, VBP Managers and other cross functional teams in the management of multiple VBP relationships including Provider Groups (IPAs) and the other contracting entities like ACOs and potentially DSRIP PPSs.
Work collaboratively with Contract Management to design and refine, the VBP contract negotiated with each assigned VBP Provider Group partnership.
Accurately and effectively communicate the status of each VBP relationship to the VBP team and other cross-functional leads.
Recommend reporting enhancements based on VBP partner feedback and needs identified through regular use of the existing reporting tools.
Appropriately prioritize and escalate VBP issues to the AVP and Managers of VBP Initiatives.
Work with the Manager / Lead of each VBP partner to develop strategies and action plans designed to eliminate any aberrant utilization and or quality of care patterns that will prevent the VBP partner from having a successful outcome through its Fidelis VBP relationship.
Assist internal and external VBP meetings (clinical, IT, legal, etc ) in order to resolve any issues related to the operation of those VBP relationships that have been assigned.
Assist in tactical execution of the business plan objectives to drive success of each VBP relationship.
Assist in building and maintaining relationships with key individuals at assigned PPS organization and their related VBP contracting entities.
Act as a subject matter expert on all VBP related matters.
Assist in implementation for VBP assigned relationships including third party vendors.
Provide daily assistance in the management of VBP activities, including data analysis, problem resolution and other activities to assist in the facilitation of a successful relationship with assigned Provider Group Partners.
Performs other duties as assigned.
Complies with all policies and standards.