Responsibilities:
- Develops, implements, manages and maintains operational systems and activities.
- Serves as a liaison with all levels of the organization and outside community.
- Manages multiple priorities and projects with competing deadlines.
- Allocates time to meet completion requirements.
- Serves as a coach and mentor for other positions in the department.
- Reviews and monitors adherence to Human Resources policies and corporate compliance procedures.
- Other duties as assigned.
Departmental Specific Job Responsibilities:
- Serves as a liaison with all levels of the organization as well as payor and other outside partners.
- Develop an expert-level knowledge of performance levers including attribution, quality, utilization, and risk documentation.
- Supports data collection, analysis, reporting, and supplemental data efforts for value based contract performance.
- Prepares and implements action plans to drive quality, cost, and utilization performances.
- Validates the accuracy of payor quality reports and communicate discrepancies. Takes actions to correct the discrepancies.
- Drives performance on value based contracts by driving joint payor and CC initiatives.
- Develops and manages programs to ensure value based payment contractual obligations including care delivery, quality, financial, and legal are met.
- Establish, influence, and manage internal and external cross-functional relationships to ensure the effective execution of initiatives.
- Partners across the enterprise to implement value based contracts and drive value based contract performance with cross-functional partners including but not limited to Value Based Operations, Navigation Team, Contract Nurses, Medical Economics, Enterprise Analytics, Contracting, Payor Operations, Quality Alliance (independent practices), and CCF Institutes, Hospitals, and third parties.
- Reviews contract performance against expectations and help guide future value based payment model direction to strengthen our value proposition, improve our competitive position, and meet goals and objectives.
- Works in a team environment and partner within Market Network Services with Contract Managers to incorporate value based payment models into health plan agreements.
- Keeps up to date on industry and patient trends within the Commercial Health Plans, Employer Health, State and Federal insurance industry.
- Supports development of strategic summaries, positioning documents, and executive presentations that clearly and professionally communicate to senior level audiences.
- Analyzes industry trends, patient needs, and internal performance to deliver data-driven insights to support actionable strategic direction, prioritization, and strategy communication.
- Manages multiple priorities and projects with competing deadlines.
- Explores opportunities to add value to job accomplishments.
- Enhances department and organization reputation by accepting ownership for accomplishing new and different requests.
- Other duties as assigned.
Education:
- Bachelor's degree in Business Administration, Healthcare Administration or related field.
- Master’s degree preferred.
Certifications:
- May be required for specific positions as per policy or regulation.
Complexity of Work:
- Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
- Must be able to take appropriate action in a stressful environment.
- Demonstrated team, leadership, organizational, financial management and problem solving skills.
- Knowledge of statistical and financial analysis, primary research and business plan development.
- Strong presentation, communication and training skills required for most positions.
Work Experience:
- Minimum of six years of related experience; healthcare setting preferred.
- Offset: Master’s degree and five years of experience.
Preferred Work Experience:
- Minimum of six years of value based contract related work experience
- Experience with Medicaid and Medicare
- Experience working in a health system, hospital, medical practice, or payor organizations preferred. Experience and working knowledge of health care business basics including, physician practice workflows, provider billing, risk coding, and payor contracting preferred.
- Experience in quality and financial performance process improvement preferred.
- An understanding of the fundamentals of patient-centered health care preferred.
Preferred Skills and Knowledge:
- Effective relationship building skills are required.
- Strong project management and organizational skills required. Proven ability to complete large, complex projects in an accurate, timely and autonomous fashion required.
- Excellent verbal and written communication skills including a proven ability to prepare clear, concise presentations that inspire and motivate others required.
- Strong analytic skills and experience in analyzing and identifying performance improvement opportunities using quality, cost, and utilization data preferred.
- Knowledge of ACO, Medicaid, and Medicare Advantage quality measures, NCQA and HEDIS standards, and Medicare Advantage star ratings gained through experience preferred.
- Demonstrated ability to function effectively in a dynamic, fast-paced, and ambiguous environment.
Personal Protective Equipment:
- Follows Standard Precautions using personal protective equipment as required for procedures.
#LI-WG1 #LI-REMOTE
Keywords: Value Based Care, Value Based Contracts, Value Based Performance, Value Based Program, Medicaid, Medicare, Population Health
Pay Range
Minimum hourly: $40.48
Maximum hourly: $61.74
The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic’s benefits package, which includes among other benefits, healthcare/dental/vision and retirement.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
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Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after one year.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.