Value-Based Care and Contracting Manager

Job Overview:

The Value-Based Care and Contracting Manager will be responsible for driving strategies to optimize value-based reimbursement opportunities and managing payer relationships. This position involves negotiating contracts, overseeing Accountable Care Organization (ACO) initiatives, and ensuring compliance with healthcare regulations. The role requires close collaboration with various internal teams and external stakeholders to enhance financial performance, improve patient outcomes, and maintain regulatory compliance.

Core Responsibilities:

In this role, the manager will lead efforts to develop and execute strategies for value-based reimbursement, working alongside clinical and financial teams to align objectives and identify areas for improvement. Their responsibilities will include analyzing financial and operational data to help the organization stay competitive in the evolving healthcare landscape.

The manager will be the primary contact for payer contract negotiations, ensuring agreements are beneficial and in line with regulatory requirements. This includes addressing payer-related issues and securing optimal terms to maximize reimbursement and financial results.

Additionally, they will oversee ACO programs, focusing on performance management, compliance, and enhancing the quality of care and patient satisfaction. The role involves coordinating with clinical and administrative staff to ensure the successful implementation of ACO initiatives.

Regulatory compliance is another key area of responsibility, requiring the manager to stay updated on healthcare regulations and payer policies. They will establish policies and procedures to ensure compliance with federal, state, and local laws related to value-based care and ACO operations.

The manager will also be responsible for conducting thorough data analyses of financial and reimbursement trends, preparing reports for senior leadership, and providing strategic insights to guide decision-making.

Qualifications:

The ideal candidate will have a Bachelors degree in healthcare administration, business, finance, or a related field, with a preference for candidates holding a Masters degree. A minimum of five years of experience in healthcare administration, value-based reimbursement, payer relations, or ACO management is required. The candidate must demonstrate a strong ability to negotiate contracts, manage payer relationships, and perform financial analysis within a healthcare environment.

Candidates should possess strong knowledge of value-based care models, excellent communication and negotiation skills, and the ability to balance multiple priorities in a dynamic setting. Problem-solving skills, familiarity with healthcare regulations, and experience working in a matrix organization will also be important for success in this role.