Program Manager IV - Value Based Performance

• This position is remote in North East Ohio. They anticipate to be on site in Cleveland one to two times per month.

• Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world. As part of the CCHS Value Based Performance team, the Program Manager will help support value based contracting, implementation, program management, and performance management for value based contracts and programs with commercial payors. The Value Based Performance Program Manager IV serves as a key member of Value Based Performance Team for assigned commercial value-based contracts implementation, performance, and maintenance of designated value based programs. Acts as a liaison between department and internal as well as external stakeholders. This position works collaboratively with internal teams including Value Based Operations, Navigation Team, Contract Nurses, Medical Economics, Enterprise Analytics, Contracting, Payor Operations, Product Team, Quality Alliance (independent practices), and CCF Hospitals, as well as external teams from various national and regional payor stakeholders to achieve the Triple Aim of reducing cost, improving quality, and optimizing patient experience. The role is key to the development and implementation of initiatives and programs to support the CCHS value based strategy. This includes performing industry and regulatory analysis that will be used to identify, evaluate, and develop recommendations to support value based contracting, planning, and execution The ideal caregiver is someone who: • Acts as a liaison between department and internal as well as external stakeholders. • Can develop and implement initiatives and programs to support the Cleveland Clinic value based strategy. • Is experience with conflict resolution and problem-solving. • Has written and verbal communication skills. • Has teamwork and motivational skills. • Has organizational and multitasking skills. This is a rewarding opportunity that offers growth-oriented projects, mentorship, support, and resources. You will experience great exposure to both the institute and department leadership and have numerous opportunities for career growth in different administrative and project/program management At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Responsibilities:

• Develops, implements, manages and maintains operational systems and activities.

• Serves as a liaison with all levels of the organization and outside community.

• Manages multiple priorities and projects with competing deadlines.

• Allocates time to meet completion requirements.

• Serves as a coach and mentor for other positions in the department.

• Reviews and monitors adherence to Human Resources policies and corporate compliance procedures.

• Other duties as assigned.

Departmental Specific Job Responsibilities:

• Serves as a liaison with all levels of the organization as well as payor and other outside partners.

• Develop an expert-level knowledge of performance levers including attribution, quality, utilization, and risk documentation.

• Supports data collection, analysis, reporting, and supplemental data efforts for value based contract performance.

• Prepares and implements action plans to drive quality, cost, and utilization performances.

• Validates the accuracy of payor quality reports and communicate discrepancies. Takes actions to correct the discrepancies.

• Drives performance on value based contracts by driving joint payor and CC initiatives.

• Develops and manages programs to ensure value based payment contractual obligations including care delivery, quality, financial, and legal are met.

• Establish, influence, and manage internal and external cross-functional relationships to ensure the effective execution of initiatives.

• Partners across the enterprise to implement value based contracts and drive value based contract performance with cross-functional partners including but not limited to Value Based Operations, Navigation Team, Contract Nurses, Medical Economics, Enterprise Analytics, Contracting, Payor Operations, Quality Alliance (independent practices), and CCF Institutes, Hospitals, and third parties.

• Reviews contract performance against expectations and help guide future value based payment model direction to strengthen our value proposition, improve our competitive position, and meet goals and objectives.

• Works in a team environment and partner within Market Network Services with Contract Managers to incorporate value based payment models into health plan agreements.

• Keeps up to date on industry and patient trends within the Commercial Health Plans, Employer Health, State and Federal insurance industry.

• Supports development of strategic summaries, positioning documents, and executive presentations that clearly and professionally communicate to senior level audiences.

• Analyzes industry trends, patient needs, and internal performance to deliver data-driven insights to support actionable strategic direction, prioritization, and strategy communication.

• Manages multiple priorities and projects with competing deadlines.

• Explores opportunities to add value to job accomplishments.

• Enhances department and organization reputation by accepting ownership for accomplishing new and different requests.

• Other duties as assigned.

Education:

• Bachelor's degree in Business Administration, Healthcare Administration or related field.

• Master's degree preferred.

Certifications:

• May be required for specific positions as per policy or regulation.

Complexity of Work:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

• Must be able to take appropriate action in a stressful environment.

• Demonstrated team, leadership, organizational, financial management and problem solving skills.

• Knowledge of statistical and financial analysis, primary research and business plan development.

• Strong presentation, communication and training skills required for most positions.

Work Experience:

• Minimum of six years of related experience; healthcare setting preferred.

• Offset: Master's degree and five years of experience.

Preferred Work Experience:

• Minimum of six years of value based contract related work experience

• Experience with Medicaid and Medicare

• Experience working in a health system, hospital, medical practice, or payor organizations preferred. Experience and working knowledge of health care business basics including, physician practice workflows, provider billing, risk coding, and payor contracting preferred.

• Experience in quality and financial performance process improvement preferred.

• An understanding of the fundamentals of patient-centered health care preferred.

Preferred Skills and Knowledge:

• Effective relationship building skills are required.

• Strong project management and organizational skills required. Proven ability to complete large, complex projects in an accurate, timely and autonomous fashion required.

• Excellent verbal and written communication skills including a proven ability to prepare clear, concise presentations that inspire and motivate others required.

• Strong analytic skills and experience in analyzing and identifying performance improvement opportunities using quality, cost, and utilization data preferred.

• Knowledge of ACO, Medicaid, and Medicare Advantage quality measures, NCQA and HEDIS standards, and Medicare Advantage star ratings gained through experience preferred.

• Demonstrated ability to function effectively in a dynamic, fast-paced, and ambiguous environment.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

#LI-WG1 #LI-REMOTE

Keywords: Value Based Care, Value Based Contracts, Value Based Performance, Value Based Program, Medicaid, Medicare, Population Health

Pay Range

Minimum hourly: $40.48

Maximum hourly: $61.74

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.