MANAGER OF VALUE-BASED PRODUCTS - HEALTH PLAN SERVICES

Cook County•Chicago, IL

About The Position

The Manager of Value-Based Products will support value-based arrangements aimed at improving quality, enhancing experience, promoting equity, and reducing costs for patients and members served by Cook County Health (CCH). This position will be responsible for negotiating and administering delegated risk arrangements on behalf of Cook Medical Group (CMG) locations throughout Cook County. Currently, Cook Medical Group holds a delegated, partial-risk commercial contract with Blue Cross Blue Shield Illinois (BCBS IL) for employer and marketplace plans and the Manager will lead the day-to-day operations for this agreement.

Requirements

Bachelor’s degree from an accredited college or university is required (Official transcripts are due at the time of interview)
Three (3) years' experience in healthcare administration or managed care supporting Medicare, Medicaid and/or Commercial insurance products is required
One (1) year of experience with value-based contracting and/or delegation in a managed care setting is required
Experience with health plan operations, such as claims processing, network management, utilization management, care management and/or member services is required
Proficiency in Microsoft Office (PowerPoint, Word, Excel, and Outlook) is required

Nice To Haves

Two (2) years of work experience interfacing with diverse stakeholders, including but not limited to provider organizations, health plans, regulators, and/or community organizations
Prior experience with Commercial employer and/or marketplace products
Experience presenting, reporting, and conducting quantitative analysis
Prior finance and budget experience
Prior experience implementing change management in a complex organization

Responsibilities

Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Contribute to the management of CCH staff and CCH’ systemic development and success
Discuss and develop CCH system policies and procedures
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Develops and implements workflows, trainings, and policies and procedures to support risk-based arrangements
Collaborates with senior leaders in clinical, care coordination, customer service, and other departments to deliver excellent quality of care and experience
Analyzes data and prepares financial, clinical, and operational reports
Liaises with BCBS IL and other payers on behalf of CMG
Manages and oversees CMG staff and other contracted vendors
Supports the negotiation and execution of provider and vendor agreements
Ensures all managed care contract requirements are met
Facilitates monitoring and auditing of CMG-related operations
Supports members and providers with issue resolution
Identifies and implements process improvements with focus on achieving better quality outcomes, enhancing experience, promoting equity, and controlling costs
Identifies and pursues opportunities for expansion and innovation in value-based care, with initial focus on CMG commercial products
Performs other duties as assigned