Value Based Care Account Manager I/II @ Univera Healthcare

Job Description

Summary

The Value Based Care Account Manager role manages and coordinates the network partnership activities. The incumbent ensures that the Health Plan and Provider are compliant with the terms of assigned Strategic Partnership Agreements and the Accountable Cost and Quality agreements (ACQA) with varied organized health care entities.

The incumbent drives the success of the partnership and ACQA arrangements to support the Health Plan cost and quality goals. The Account Manager collaborates with Finance and Quality Health Information (QHI) in developing and producing financial and quality reporting to facilitate the success of the arrangements. This position collaborates with Product Development and Sales in the product design and development of product suites as part of strategic Provider Partnerships. This position collaborates with necessary stakeholders to ensure development and implementation of partnership initiatives as required.

This position keeps management apprised of issues and status; identifies opportunities for improvement; and acts as a catalyst for change. This position is responsible for the building and maintaining of favorable relationships with these entities; coordinating internal resources; ensuring deliverables are meaningful, timely and accurate; and issue resolution. This position is the primary liaison for assigned ACQA and/or Partnership arrangement and serves as an internal expert.

Essential Accountabilities

Level I

• Organizes and oversees the network partnership forums including joint operations committees and quarterly meetings.
• Responsible for the day-to-day oversight of Network Partnership arrangements, including facilitating resolution of partnership issues and ensuring compliance with Network agreements.
• Acts as the internal expert and point person for information regarding the Network Partnership Value Based Care arrangements including physicians, executives and senior leadership at applicable hospital, health systems, IPAs and ACOs.
• Identifies and pursues opportunities for improvement within the arrangement. Including the coordination of internal efforts to identify opportunities and potential programs for Provider Partners to facilitate success of the ACQA; including coordination with Physician Performance Improvement, Quality Health Analytics, Finance, Actuarial, Program Management, UM/Member Care Management and Executive leadership.
• Coordinates and leads internal efforts to develop, implement, support and monitor ACQAs. Including coordinating deliverables, dashboard reporting, meeting schedules, system implementation and issue resolution.
• Coordinates and leads internal efforts to develop, implement, support and monitor Provider Partnerships. Including coordinating contractual deliverables, dashboard reporting, coordinating collaborative initiatives between the Provider Organization and Health Plan including Product Development, Marketing of Co-branded Products, Medical Management initiatives, and alignment of administrative functions.
• Ensures compliance and resolution of operational issues arising from Article 43 and Article 44 network contracts to include delegation of core functions.
• Develops/implements and track network specific metrics and physician organizational assessment tools for the purposes of monitoring and maintaining network partnerships and ACQAs.
• Assists the Network Management leadership with the negotiation of Network Partnership and ACQA agreements
• Keeps informed of developments and innovations in health care delivery systems both locally and regionally.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

• Represents the Health Plan on Regional Planning and Governmental Committees (e.g., Regional Health Planning Commissions, Regional Health Information Organization Board).
• Conducts detailed analysis to draw conclusions and develop pertinent recommendations to improve quality and efficiency for member populations. Presents findings and recommendations to Health Plan and Provider Leadership.
• Assists Health Plan Sales staff in educating current and potential Employer Groups regarding Innovative Provider Payment programs and the value story.
• Mentors junior staff.

Minimum Qualifications

NOTE

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Bachelor’s degree in related field required. Master’s degree in related field preferred.
• Must have minimum five years’ analytical experience in health care field, finance contract negotiations or health care reimbursement.
• Strong communication and interpersonal skills.
• Strong analytical skills and ability to assess situation and make recommendations.
• Must have a current and thorough understanding of health care, financial models, physician organizations, contracts, and the Health Plan’s products, and must be able to effectively discuss these issues with others.
• Knowledge of care management programs and their impact to Providers and Members.
• Must be able to work constructively with external contacts including hospital administrators, owners of provider companies, physicians, provider organization leaders and other providers.
• Demonstrated ability to build effective working relationships with individuals and groups at all levels within the Health Plan and its affiliated plans.
• Excellent organizational and management skills.
• Knowledge of Physician reimbursement methodologies.
• Knowledge of complex Independent Practice Association (IPA), Physician Hospital Organization (PHO), Physician Organization (PO), and Integrated Delivery System (IDS) partnership strategies.

Level II (in addition to Level I Qualifications)

• Minimum of ten years in Contract Negotiations or Provider Partnership Administration (value-based care and/or integrated delivery) required.
• Demonstrate ability to conduct detailed analysis and present findings and recommendations to senior leadership.
• Demonstrates ability to lead partnerships independently.

Physical Requirements

• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s)

Level I: Grade E5: Minimum $71,880 - Maximum $129,384

Level II: Grade E6: Minimum $79,068 - Maximum $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.