Manager, Value Based Performance

Manager, Value Based Performance

The Manager, Value Based Performance oversees all aspects of the company’s health population systems, healthcare analytics, special projects and initiatives. This position is responsible for developing projects, reports and meaningful healthcare insights for various patient populations. The Manager, Value Based Performance will use their expertise to provide recommendations on cost/utilization trends, clinical transformation, quality/coding and process improvement initiatives. This position will make executive level presentations and ensure the integrity of the data in the system. The Manager, Value Based Performance will maintain working relations with the company’s clinical integration team, care coordinator team, coding/quality team and providers. This position will also work in partnership with multiple directors and senior executives throughout all areas of the organization and work closely with The Center for Medicare / Medicaid and various private insurance companies. This position will report to the Director of Value Based Performance with dotted line to the Medical Director of Value Based Programs.

We are flexible to a remote or hybrid work schedule.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Oversees and is responsible for the following

• Performs other related duties as assigned or requested.
• Coordinate and maintain aggregation and integrity of data being delivered by CMS, private payers and third-party data vendors.
• Financial performance reports on a periodic and ad-hoc basis for Care Coordination staff as well as physicians and executive leadership
• Maintains a working knowledge of relevant Government and third-party health care initiatives in which the company participates. It is assumed, in-order to maintain these skills, that relevant seminars, books, periodicals and regulations be routinely reviewed.
• Fully supporting the staff in their use of the system. Maintaining manual with standard operation procedures and instructions.
• Ensures accuracy and timeliness of company’s staff and physician reports to include regularly scheduled and ad-hoc reporting requests. Responsible for all follow-up and/or research requests regarding physician data
• Prepares reports, presentations and other documents and presents these materials in meetings.
• Maintains a comprehensive working knowledge of company’s electronic health record and population management system workflow
• Reporting of monthly financial and utilization metrics
• Devise creative solutions to accommodate partial data sets and custom data formats
• Identifying high risk patient cohorts
• Participates in project teams, analyzing various new programs, projects or ventures that require analysis of health population data
• The validation of clinical data from multiple sources to create reports for both external and internal use

Education / Experience / Skills

• Minimum of 5 years’ experience in Healthcare and Healthcare data analytics required; an understanding of Electronic Medical Records and population management system strongly preferred
• IT systems, database design, or data structures
• Knowledge/use of analytic tools (e.g. Lightbeam, Excel, SQL, Access, SAS)
• Bachelor’s in Business Administration, Actuarial Science, Finance, Computer Science, Information Technology, Healthcare Administration or related field required
• Translating complex topics into simple terms
• SQL coding
• Knowledge of Medicare Advantage plans, MSSP Accountable Care Organizations (ACO) and Commercial ACOs a plus
• Self-starter with the ability to work independently and as a team
• Ability to interact with executive management
• Master’s degree preferred

Supervisory Responsibilities

This job has 3-4 direct reports.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Analysis/Problem Assessment – Securing relevant information and identifying key issues and relationships from a base of information; relating and comparing data from different sources; identifying cause-effect relationships.

Compassion - The responsibility to put a patient’s or person’s interests first, including the duty not to harm, deliver proper care, and maintain confidentiality.

Compliance - Employee has satisfactory completed employers required compliance training. Employee is able to demonstrate an understanding of employers Code of Conduct.

Communication - Expressing ideas effectively in individual and group situations (including nonverbal communication); adjusting language or terminology to the characteristics and needs of the audience. Good listening skills.

Follow-up - Consistently maintaining a high activity or productivity level

Initiative - Making active attempts to influence events to achieve goals; self-starting rather than accepting passively; taking action to achieve goals beyond what is required; being proactive. Practices self-development.

Integrity - Maintaining and promoting social, ethical, and organizational norms is conducting internal and external business activities.

Judgement/ Problem Solving - Recognizes problems and responds, systematically gathers information, sorts through complex issues, seeks input from others, addresses root cause of issues, makes timely decisions, can make difficult decisions, uses consensus when possible, and communicates decisions to others.

Patient Service Orientation - Proactively developing patient/customer relations by making efforts to listen and understand the customer and their needs (both internal and external); anticipating and providing solutions to customer needs; giving high priority to patient/customer satisfaction. Ensures appropriate follow up and is their advocate in determining solutions. The employee uses a variety of communication techniques to effectively express thoughts and ideas and to understand or influence.

Results Driven & Execution - Accountable for meeting or exceeding individual and/or department goals and objectives. Committed to producing results that will achieve company objectives. Sets priorities and organizes time to meet or exceed goals, follows up, and takes personal responsibility for results whether they are positive or negative.

Teamwork/ Collaboration - Working effectively with team/work group or those outside formal line of authority (e.g., peers, senior managers) to accomplish organizational goals; taking actions that respect the needs and contributions of others; contributing to and accepting the consensus; subordinating own objectives to the objectives of the organization or team. Listens to others and values opinions.

Language Skills

Ability to read, analyze, and interpret common financial reports and contracts. Ability to respond to inquiries from internal customers. Ability to effectively present information to management and/or end users.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Analytical / Interpretive Skills

Ability to analyze and interpret the raw data and data trends to properly communicate to the management and end users to create action oriented plans that will result in positive movement of measures. Also, have the ability to understand the business implications and goals of the data being presented.

Computer Skills

To perform this job successfully, an individual should have advanced knowledge of Microsoft Excel software, including use of pivot tables and other advanced data manipulation techniques; Microsoft Word; Microsoft Excel; Microsoft Access; Microsoft PowerPoint, SQL Server, SSRS and Adobe Software Suite.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.