CareOregon Hiring For Director, Value Based Contracting at Portland, OR  Full Time

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment.

Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon’s standard accommodation process.

Position Title: Director, Value Based Contracting

Department: Contract Management

Title of Manager: Vice President, Provider Contracting

Supervises: Provider Contract Team

Exemption Status: Exempt

Requisition ID: 19687

General Statement of Duties

This position is responsible for leading the execution of provider contracting strategy and activity across the organization. The majority of time is focused on business group oversight, with secondary time on enterprise-wide engagement. Primary duties include technical and operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization.

Essential Position Functions

Technical/Operational Leadership

• Directs provider contracting services across all areas of the organization in support of Medicaid, Medicare, and other populations.
• Leads the execution of strategic initiatives, plans, and goals for areas of oversight in alignment with organizational vision and goals.
• Develops, operationalizes, and maintains effective alternative payment models to support delivery system transformation in partnership with internal and external teams (e.g., PCP Payment Model, Risk Agreements).
• Ensures Network and VBP strategies are supported by evidence base and best practices that relate to the models being developed; integrates findings into the design of methodologies.
• Works with internal leaders in the development, implementation, and maintenance of quality payment strategies and risk models within regional networks.
• Develops and maintains process to evaluate financial and network impact of alternative payment methodologies and continually review and adjust strategies accordingly in conjunction with actuarial staff.
• Assists in the development, implementation and maintenance of analytical plans and evaluation plans of developed models in quality of care, health care utilization, and cost trends as necessary for the program.
• Oversees and ensures the timely completion of value-based payment regulatory reporting.
• Develops or ensures internal systems and measures are in place to support effective, efficient, and compliant operations.
• Provide oversight of the development and maintenance of policies, procedures, structures and training to support the staff and department into the future.
• May serve as a sponsor or chair for key projects and initiatives.
• Effectively articulate and disseminate models and innovation results using a variety of communication channels to include written reports, graphic data display, PowerPoint presentations, speaking engagements, and manuscript publications.

• Leads the oversight of alternative value based payment strategies in partnership with NCS that supports delivery system transformation across multiple mechanisms of payment (payment methodology, incentive payments and shared savings, grant programs, etc.).
• Develops, operationalizes, and maintains a Network Risk Strategy that supports the Network, Members and CareOregon’s needs and capitalizes on the existing Risk Model work, regional and national initiatives.
• Participates in the development of vision, goals, and strategic plans across business teams and regions.
• Develops short and long term plans and policies; oversees the development and execution of standard operating procedures.
• Provides input into strategic plans of the organization.
• Maintains a business unit and member view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

• Recommends budgets in alignment with short and long term plans.
• Manages resources to ensure priorities are accomplished.
• Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.

Relationship Management

• Builds and ensures effective relationships across internal teams, line of business customers/stakeholders, and external organizations for current or future integration.
• Partners with internal leaders and managers in identifying improvement plans and processes.
• Works closely with the internal leaders to ensure that agreements, relationships, reporting and programs are properly supported for our members and our network partners.
• Cultivates strong business relationships with the provider community.
• Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.
• Leads effective communication system for work group(s), ensuring a collaborative culture.

People Management

• Directs team(s) and establishes team and management goals.
• Provides team members with ongoing understanding of business unit plans and expectations.
• Performs employment functions in collaboration with Human Resources, including staffing, recruitment, performance management, professional development, and termination.
• Coaches, motivates, and recognizes staff.
• Creates opportunities for professional development.
• Leads the development of performance goals, measurement, and evaluation of results.
• Ensures participation in required training initiatives and organizational activities, as well as adherence to external regulations and internal policies.
• Drives a culture of success in alignment with the organizational mission, vision, and values.
• Provides support and coaching to teams working in a complex matrix environment.

Essential Department and Organizational Functions

• Supports and operates in alignment with the organization’s core values.
• Strives to meet work goals that contribute to departmental and organizational goals.
• Adheres to organizational standards, policies and procedures, as well as compliance requirements.
• Performs other duties as assigned.

Knowledge, Skills and Abilities Required

• Extensive knowledge of managed care and the Oregon Health Plan
• Demonstrated depth of experience in building relationships with multiple entities, including providers and community stakeholders
• Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies
• Knowledge of complex and alternative reimbursement arrangements
• Knowledge of federal Medicare regulations and state Medicaid rules (OARs)
• Knowledge of claims administration and ability to implement contract reimbursement terms
• Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), and ability to perform rate calculations
• Knowledge of physician group, hospital, and facility operations
• Thorough knowledge of principles and statistical methodologies for program assessment and evaluation
• Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
• Demonstrated leadership effectiveness and ability to design and implement constructive change
• Strong people management skills, including the ability to coach and motivate teams
• Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives.
• Excellent critical thinking, analytical and problem-solving skills
• Ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
• Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
• Highly skilled in resource management
• Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
• Ability to influence and build consensus
• Ability to work in an environment with matrix reporting, diverse individuals and groups

Physical Skills and Abilities Required

Lifting/Carrying up to 10 Pounds Pushing/Pulling up to 0 Pounds Pinching/Retrieving Small Objects Crouching/Crawling Reaching Climbing Stairs Repetitive Finger/Wrist/Elbow/ Shoulder/Neck Movement

0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day

Standing Walking Sitting Bending Seeing Reading Hearing Speaking Clearly

0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

• Minimum 10 years’ progressively responsible experience in contracting and/or provider network systems
• Minimum 4 years’ supervisory experience

Preferred:

• Management experience in a managed care organization or practice setting
• Value based contracting experience
• Provider relations experience

Working Conditions

• Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

Inside/office Clinics/health facilities Member homes

Other_________________________________________

• Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
• Equipment: General office equipment
• Hazards: n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.