OverviewM Health Fairview has an immediate opening for a Senior Manager of Value-Based Care Performance to join our team based out of our Midway Corporate campus in St. Paul, MN. This is a full time, salaried/exempt, beneifts-eligible opening. M Health Fairview offers a competitive benefits package including medical insurance - as low as $0, dental insurance - also a $0 option, PTO (24 days per year), and 403B with up to a 6% employer match; visit www.fairview.org/Benefits/noncontract to learn more and get all the details!Responsibilities Job Description
Accountable for evaluating, tracking/monitoring and facilitating identification of potential opportunities within value-based care (VBC) contracts including both total cost of care (TCOC) and pay for performance (P4P) contracts and any additional incentives or programs offered by payers that Fairview Health Services participates.
Works under the direction of a primary care director of operations and collaboratively partners with key services including: data analytics, payer relations, quality including care maps, specialty service lines, Fairview Physician Associates Network and primary care program managers, leaders and clinicians.
Directs a team that partners with payer relations and quality for improvement and development of new key leading and lagging metrics related to value contracts including financial, utilization, trends of spend/use or outliers and comparison to benchmarks that enable prediction of future performance as well as understanding of current opportunities.
As potential opportunities are identified in data, works with appropriate partners to understand if they represent expected outcome of services provided at Fairview or impactable opportunities and identifies the financial impact to enable operational leaders to understand the value of investments to achieve those outcomes.
Partners with payer relations to evaluate existing contracts for current and future performance year over year and evaluate new contract terms in partnership with operations to understand what would be impacted and in what quantity to achieve levels of performance so they can use that data to develop the potential cost to achieve.
Collaborates with stakeholders across the organization and continuum of care to understand data and efforts existing or planned that will impact VBC positively or negatively.
Develops system methodology for tracking value-based care initiatives to assure reliable and improved performance in the M Health Fairview organization including development of metrics that evaluate health equity across all dimensions of performance.
Provides data that is visualized and easy to interpret as well as insights on that data to clinicians and operational leaders on their performance.
Maintains knowledge of how each payer measures performance in cost and quality, assists analytics to normalize data wherever possible across payers to enable clear understanding of performance at individual, clinic, and practice levels that enable targets to be set on a single scale while being able to translate those by contract to anticipated/actual performance.
Provides leadership and subject matter expertise on the best ways to use available data to estimate performance, identify meaningful opportunities and provide meaningful visualizations on performance that enable clinicians and leaders to see trending and understand impactable components.
Prepares/assists in the financial forecast and monitors program/project health for monthly variances to plan. Collaborates with and motivates others to achieve program/project goals and objective.
Creates a collaborative environment despite ambiguity and uncertainty providing tools and resources to address the needs of teams and workgroups around initiatives.
QualificationsRequired
Bachelor’s degree or higher degree in business, computer science, information technology, business or data analytics or related field or a combination of equivalent education and experience.
Minimum 5 years experience in relevant field including healthcare, quality or process improvement, direct patient care or healthcare analytics.
1-2 years previous experience in value-based care analytics, performance measurement and data visualization
Strong organizational skills demonstrated analysis and problem-solving skills.
Ability to work independently with strong vision and deliverables aligned with strategic goals.
Excellent oral and communications skills.
Demonstrated ability to establish and maintain working relationships with peers and stakeholders at all levels of the organization.
Understanding of clinical operations and tools used in Epic
Preferred
Masters degree in business, computer science, information technology, business or data analytics
Experience with and knowledge of advanced alternative payment models, including advanced government models (ACOs, IHP), Merit-Based Incentive Payment systems (MIPS), MACRA legislation, Minnesota Community Measures (MNCM), Quality Payment Programs (QPP), Primary Care Direct, Bundled Payment programs, Medicare Advantage, and other value-aligned initiatives.
Expertise in population health, quality, or directly in primary care – knowledge of practices that support health disparities, variations in the population serviced, and provider alignment initiatives.
Background or experience in clinical operations and quality.
Previous experience with payer relationships/product development around value-aligned specifications
A track record with clinical programs and models of care. Experience with care management and at-risk patient populations.
Previous people leadership experience
Formal project management or improvement methodology certification.
EEO StatementEEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status
