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CareSourceCA

Director, Enterprise Value Based Reimbursement Strategy(Required Experience In V

CareSource is a nonprofit managed care organization based in Dayton, Ohio, that serves over 2 million members with a wide array of Medicaid and Medicare products.

CareSource

Employee count: 1001-5000

Salary: 111k-194k USD

United States only

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Job Summary:

The Director, Enterprise Value Based Reimbursement (VBR) Strategy serves as the enterprise-wide VBR strategy lead to all markets and lines of business. The Director will lead ongoing engagements with market leadership to build VBR strategy plans, collaborate with state partners around VBR strategy, and coordinate VBR program solutions for markets.

Essential Functions:
  • Support the development and execution of both enterprise-level and market-specific value-based reimbursement (VBR) strategies to enhance organizational alignment and effectiveness across various markets and lines of business.
  • Collaborative with market leadership on VBR strategies that address specific requirements for Request for Proposals (RFPs), and continue collaboration post-RFP to build and implement effective VBR program plans.
  • Partner closely with market leadership to ensure compliance with state-level VBR requirements and commitments by leveraging appropriate strategies and programs to meet regulatory expectations.
  • Build strong, influential, and collaborative relationships with key internal stakeholders and external partners to shape and drive VBR program strategy.
  • Lead discussions with healthcare providers and organizations that are instrumental in fostering enterprise-wide VBR partnerships.
  • Continuously evaluate and adjust VBR programs to ensure they remain in alignment with enterprise objectives, enhancing their impact and relevance.
  • Oversee the development and operationalization of policies, standards, benchmarks, performance metrics, and quality control mechanisms to ensure high standards in VBR strategy execution.
  • Maintain up-to-date knowledge of regulatory changes and market-specific performance standards to guarantee compliance and ensure timely execution.
  • Lead negotiations and contract discussions with healthcare providers identified as providing innovative care solutions that support a comprehensive national VBR approach.
  • Provide leadership, mentorship, and professional development opportunities to staff, fostering a supportive environment that encourages growth and excellence in performance.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in management, healthcare management or related field is required
  • Master's degree is preferred
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Five (5) years of experience in value-based reimbursement design, methodologies and/or VBR contracting, data analysis, reporting, or data support is required
  • Three (3) years of Provider contracting or Provider relations is required
  • Five (5) years of leadership/management experience is required
Competencies, Knowledge and Skills:
  • Proficient in Microsoft Office to include Word, PowerPoint, Access - advanced proficiency in Excel
  • Excellent team facilitation skills
  • High level of analytic skills for solving problems
  • Excellent oral, written, and interpersonal communication skills
  • Strong knowledge of Value Based Contracting methodologies and operations and/or experience in health care quality
  • Knowledge of provider contracting and familiarity with provider network operations
  • Critical listening and thinking skills
  • Problem solving skills
  • Attention to detail and work plan creation, implementation, and evaluation
  • Business acumen and strategic thinking skills, yet able to execute tactically
  • Strong relationship management skills and ability to maintain and build strong working relationships in a matrix environment
Licensure and Certification:Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Up to 15% (Occasional) travel to attend meetings, trainings, and conferences may be required

Compensation Range:

$110,800.00 - $193,800.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

  • Fostering a Collaborative Workplace Culture

  • Cultivate Partnerships

  • Develop Self and Others

  • Drive Execution

  • Influence Others

  • Pursue Personal Excellence

  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

About the job

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Posted on

Job type

Full Time

Experience level

Director

Salary

Salary: 111k-194k USD

Location requirements

Hiring timezones

United States +/- 0 hours

About CareSource

Learn more about CareSource and their company culture.

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CareSource is a nonprofit, nationally recognized managed care organization established in 1989 that has grown to serve over 2.1 million members across various states in the U.S. With its headquarters in Dayton, Ohio, CareSource administers one of the largest Medicaid managed care plans in the country. The organization offers a wide range of health insurance products, including Medicaid, Medicare Advantage, and Health Insurance Marketplace plans. CareSource stands apart by addressing the social determinants of health which significantly impact the well-being and health outcomes of its members. This mission-driven approach enables them to provide personalized care solutions that cater to the unique needs of low-income and vulnerable populations.

As part of its commitment to innovative care delivery, CareSource continually enhances its services through technology and partnerships designed to streamline access to care and improve member experiences. The organization employs nearly 5,000 individuals who are dedicated to fostering community relationships and ensuring that every member receives high-quality care when needed. Their strategic initiatives focus on improving health outcomes, operational excellence, and social equity within the healthcare realm. In addition to traditional medical services, CareSource actively engages in health education and outreach efforts that foster resilience and self-sufficiency in the communities they serve. This approach contributes to a broader aim of not just treating illness but promoting overall health and wellness in society.

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CareSource

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