Mgr, Network Development, Value Based Purchasing
Albuquerque NM 87113
Job DescriptionThis position monitors network operations for Value Based programs. This role is responsible for monitoring reporting metrics for inpatient facilities and coordinating meetings, as needed, with all participating Value Based Purchasing (VBP) providers to review metrics to facilitate internal and external interventions to improve quality of care and clinical patient outcomes. The goal is to be an operational leader for value analysis and to provide programs that are high-quality, cost efficient and improve the quality, outcomes and performance of contracted providers. Creates an annual VBP plan and reviews the performance of the plan on a regular basis. Partners with appropriate departments to develop specific targets, report on barriers and update leadership on performance as needed with available metrics.
- Recruit qualifying providers into the VBP programs and engage in network wide promotion activities to support and promote VBP programs with BH network and collaborate with PHP on providers outside of BH network.
- Develop materials to engage and train providers.
- Actively engage with providers to educate them on provider incentive programs, VBP principles and assist providers in contracting for program.
- Provide performance metrics as needed to improve performance and quality of care.
- Provide participating facilities and providers the data metrics and connects to clinical leadership at MCO level to educate, shape and assist in improving performance towards value based initiative.
- Coordinate development and run reports to each VBP program and tracking real time data on internal implementation plan and clinical interventions to improve metrics.
- Regular meetings with provider to review their performance and connect to resources for education, training and assistance if needed to develop interventions aimed at improving performance.
- Advise and work with contract manager on development of VBP contracts.
- Report progress to Quality department as it relates to HEDIS performance on IET and FUH.
- Prepare IT-generated reports quarterly, which include:
- Transferring raw report data metrics to a scorecard format and replacing current quintiles with network shifts.
- Transferring raw data metrics from IT report to tracking reports to account for improvements/retrogression of each participating facility.
- Creating finalized tracking reports (review) for program interventions, facility-identified carriers, and scorecards overtime. Creating the quarterly agenda with suggestions on actions for quarter based on metrics and network performance, preparation work on packets given to leadership (includes scorecards, graphs, updates, outliers).
- Coordinate internal interdepartmental meetings to include scheduling, claim reporting to analyze claim data for metrics and creating metric graphs for trends.
- Create agendas that include facility barriers identified in the previous quarter at facility meeting; internal implementations tracked from previous quarter preparation meeting and data sheets that include an outline of high utilization patients, high readmission and facility readmit data, age group, DX, and member count by line of business/percentage analysis.
- Track identified barriers and interventions.
- Review and trend network wide claims issues for education and resolution.
- Other duties as assigned by management.
Clinical background preferred
General Job Information
TitleMgr, Network Development, Value Based Purchasing
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date10/28/2019
Date Requisition Created10/25/2019
Work ExperienceNetwork, Supervisory
EducationBachelors (Required), Masters
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Responsibilities5+ years of progressively more responsible health care administration experience with strong preference for managed care experience. A minimum of 1 year experience in a supervisory role.Capable of managing a variety of complex issues while driving momentum of key projects. Clearly and understandably articulates goals and expectations, relating them to the business mission and direction. Ability to analyze data to model contracts and fee schedules. Database management experience. Proficient use of Microsoft Office products.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.