Value-Based Care Director and Network Strategist
7 days ago
Director, Value-Based Care and Network
Company OverviewCentral Mass Health LLC is a Medicare Advantage health plan located in Worcester, MA. We are affiliated with the largest healthcare system in Central Massachusetts, UMass Memorial Health.
This partnership provides us with access to the latest technology, research, and clinical trials, enabling us to deliver high-quality care to our members.
Salary & BenefitsThe estimated annual salary for this position is between $120,000 to $180,000 depending on experience.
We also offer a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off.
Job DescriptionVBC Program ManagementWe are seeking an experienced Director of Value-Based Care and Network to lead and execute our value-based care (VBC) and network strategy.
- Develop and implement VBC programs, including goal setting, risk structure management, operations, monitoring, and reporting.
- Negotiate, execute, and manage VBC contracts to optimize performance across key contract levers, such as attribution, risk adjustment, STARs, and other relevant elements.
- Analyze data to identify opportunities for performance improvement and develop solutions to drive results.
- Manage relationships with contracted providers and practices.
- Lead the Provider Relations team in managing provider networks, including credentialing, provider data management, and network growth opportunities.
- Contract and negotiate with hospitals and other provider types to ensure performance and network adequacy.
- BUILD strong relationships with providers to foster partnerships and explore broader value-based business opportunities.
- Monitor industry news and regulatory changes to inform strategy and identify opportunities.
To be successful in this role, you will need:
- A Bachelor's degree in business, healthcare administration, or a related field, or equivalent combination of education and experience.
- 8+ years of experience leading and executing VBC risk programs and network management & contracting, preferably in Medicare Advantage and/or managed care.
- Minimum 5 years of healthcare experience with knowledge of health plan operations, claim processing, customer service, enrollment, etc.
As a member of our team, you will have the opportunity to work closely with various departments, including Plan Operations, Clinical, Quality, Compliance, Finance, and Sales and Marketing.
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