Value Based Contracting Leader - Hybrid

EmblemHealth; New York (NY); On-site; USD 93,000 - 178,000; Full time

Job summary

EmblemHealth, Inc. is seeking an experienced leader to negotiate and manage competitive value-based contracts with multispecialty groups, FQHCs, IPAs, and hospital provider partners in New York.

You will guide cross-functional teams, oversee financial accounting, reserves, and performance metrics, and drive provider network improvements across assigned NY markets, traveling as needed.

Qualifications

• Bachelor’s degree required; MBA/MPH/MA preferred.
• 10+ years of healthcare provider experience.
• Experience with value-based plans/processes.
• Network management and contracting experience.
• Excellent communication and data analysis skills.

Responsibilities

• Negotiate and manage value-based relationships with providers.
• Lead a team of contract specialists to work cross-functionally.
• Develop and execute provider network optimization opportunities.
• Travel to NYS markets for meetings and field activities.
• Maintain contracts and ensure regulatory compliance and reporting.

Skills

Excellent communication

Contract management

Analytical skills

MS Office proficiency

Travel readiness

Education

Bachelor’s degree

MBA/MPH/MA preferred

Tools

MS Office

Job description

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com .

Need Assistance Applying? EmblemHealth provides reasonable accommodations to individuals with disabilities throughout the application and hiring process. If you need an accommodation, please contact [e-mail] so we can support your request in accordance with applicable law.

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Responsible for negotiating and managing competitive and complex value-based relationships with EmblemHealth multispecialty groups, FQHCs, IPAs, and hospital provider partners. Develop and utilize internal guidelines, strategic growth opportunities, market research, and financial standards to improve Enterprise value-based network’s performance. Working with Finance and Health Care Economics and Analytics teams, build and manage end-to-end financial accounting, reserves, and reconciliations for all value-based contracts. Lead a team of contract specialists to work cross-functionally internally and externally to manage provider relationships, standardize analyses, streamline processes, and manage performance trends to improve overall relationships with new and existing value-based providers. Travel to multiple covered areas within assigned markets in NYS to participate in provider meetings, perform engagement and field activities. Develop and execute special projects, including provider network optimization opportunities to continuously improve unit costs, pricing, value, and competitive market pricing of Enterprise value-based contracts.

• Identify, design, negotiate, contract, and manage new and existing strategic partners, including both fee-for service and value-based terms on profit sharing, downside risk, and governance requirements as required to bring value to EmblemHealth, members, and providers; responsible for EmblemHealth contracting across the value-based spectrum (P4P, Shared Savings, Shared Risk, Global Risk, Delegated, Bundles/Episodes/Specialty Programs, PPO Models).
• Research federal, state, and competitor strategies on value-based payments to align contract improvements and assure compliance with all regulatory requirements.
• Establish oversight of contract performance through defining and tracking clinical, financial, and quality metrics; maintain accountability for specific initiatives associated with productive value-based contracts.
• Serve as value-based subject matter expert for Government Programs, Legal, and Actuarial reporting on DFS/NYS/DOH regulatory requirements; respond to all routine and ad hoc regulatory reporting and requests for information (RFI/RFP).
• Maintain PADU for value-based provider contracts and ensure team contracts within established parameters.
• Ensure VBP provider contract terms are tracked, loaded, and implemented prospectively in the system.
• Identify deficiencies in individual and aggregate contract performance; develop and implement mitigation strategies, including contracting alternatives and re-negotiation opportunities.
• Work with key stakeholders internally and externally to address provider concerns; develop and execute new workflows to improve internal processes impacting value-based relationships.
• Manage end-to-end financial accounting for all value-based contracts, including capitation, purchase orders, bank accounts, reserves, financial reconciliations, and delegate claims issues.
• Lead contract reconciliations, including capitation payments, incentive payments, and quality performance; inform Finance of financial changes impacting reserves and accruals.
• Ensure maintenance of value-based contracting term databases across organization to support EmblemHealth forecasting and budgeting.
• Lead and develop team members to drive value across multiple provider types and negotiate competitive arrangements. Work on-site as required to effectively engage team members and providers.
• Define team objectives and measure performance to goal.
• Develop and manage team, empowering their success and growth through coaching and development.
• Establish foundational relationships with cross-functional leaders across stakeholder departments to influence roadmaps and support team to advance work.
• Work cross-functionally to develop and execute provider network improvement opportunities and projects, including cost optimization, trend analyses, network simplification, provider incentive programs, and other innovative initiatives to continuously improve unit costs, pricing, value, and competitive market pricing.

Qualifications

• Bachelor’s required; master’s degree preferred (MBA, MPH, MA).
• 10+ years’ relevant, professional healthcare provider experience (Required)
• Network management and contracting experience (Required)
• 3+ years’ experience in managing staff and processes (Required)
• Experience with value-based plans/processes (Preferred)
• Health plan financial operations and data analysis experience (Preferred)
• Comprehensive understanding of contractual options, healthcare economics, and competitors’ practices with ability to grasp both clinical and business concepts (Required)
• Excellent communication skills - verbal, written, presentation, interpersonal with all levels and types/levels of audiences (Required)
• Ability to develop and implement performance measures and metrics (Required)
• Proficient with MS Office - Word, Excel, PowerPoint, Outlook (Required)
• Willingness and ability to travel throughout assigned markets and participate on-site in provider meetings and field activities within the 13 downstate counties (≥10%) (Required)

Additional Information

• Requisition ID: 1000003446
• Hiring Range: $92,880-$178,200

Security Disclosure

the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.