Director, Value-Based Programs (Value-Based Contracting & (CMS LAN) Remote in FL

Ideal Candidate will have: Direct experience designing and implementing Value-Based Contracts, including shared savings, shared risk, capitation, and other CMS-aligned Alternative Payment Models (LAN Categories 2-4) for Medicare and/or Medicaid populations.

Leads and directs team responsible for value-based programs (VBP) activities.

Responsible for developing and implementing value-based strategies for lines of business impacted by the regulatory risk adjustment payment model.

Supports achievement of financial and business objectives through value-based reimbursement.

• Accountable for designing and implementing strategies to continuously improve results of existing value-based initiatives while also leading a continuous process of innovation to identify new initiatives which lead to the overall achievement of improved accuracy, compliancy and completeness in risk adjustment revenue for all government lines of business (LOB).
• Supports the strategic direction and organization of corporate initiatives to facilitate achievement of value-based financial strategy and business objectives.
• Serves as primary owner of value-based programs (VBP) and contracts annual plan by state by line of business (LOB) development and execution.
• In conjunction with health plan and quality and risk adjustment leadership, identifies providers for potential value-based care contracts, assists local network and corporate network teams in reaching out to targeted providers, develops suggested contract terms (financial and quality metrics and benchmarks, assignment of reporting responsibilities and functions within contract language etc.), sets annual targets for each value-based program (VBP)/value-based contract (VBC), and develops reports for local health plan resources to share on a regular cadence with providers to achieve goals.