Value Based Reimbursement Strategist

UPMC; Pittsburgh (Allegheny County); On-site; USD 110,000 - 140,000; Full time

Job summary

UPMC is seeking a Value-Based Reimbursement Strategist to work with primary care leadership, analyzing performance and leading clinical and financial strategies for value-based care delivery among Partners in the UPMC Health Plan.

The role requires 3–5 years in health care consulting or related value-based reimbursement programs, with a Bachelor's in business or healthcare and a preference for a Master's degree. Strong communication and leadership are essential.

Qualifications

• Proven ability to analyze performance data across provider groups.
• Experience in health care consulting and value-based reimbursement.
• Strong written and verbal communication; leadership experience.

Responsibilities

• Develops data-driven strategic plans for value-based partners.
• Acts as primary liaison for assigned partners within UPMC Health Plan.
• Coordinates with field teams to align community providers and staff.
• Maintains understanding of quality goals and incentives to maximize earnings.
• Communicates plans and progress to partners and internal teams.
• Operationalizes strategic plans with clear objectives and milestones.

Skills

Data analysis

Healthcare consulting

Population health management

Value-based reimbursement

Leadership

Communication

Education

Bachelor's Degree in business/health care

Master's degree preferred

Job description

Purpose: Turn Data Into Better Care - and Better Returns. As a Value-Based Reimbursement Strategist, you'll work side-by-side with primary care leadership to analyze performance, identify improvement opportunities, and lead clinical and financial strategies that drive value-based success. This position is directly responsible for developing and implementing the value creation strategy for each of the primary care provider groups (Partners) enrolled in the UPMC Health Plan's Value-based Reimbursement program. In this role, the Value-Based Reimbursement Strategist works directly with each Partner's dedicated leadership while coordinating across UPMC Health Plan internal stakeholders to develop and implement clinical, financial, and quality-specific goals and strategies to improve value-based care delivery for Health Plan members. The ideal candidate for this position is a highly skilled subject matter expert in value-based reimbursement programs for primary care and can provide strategic, hands-on support to Partners by (1) analyzing and synthesizing Partner-specific performance data; (2) identifying targeted opportunities for improvement; and (3) coordinating and implementing in collaboration with the Partner and UPMC Health Plan on Partner-specific clinical improvement strategies. This job will be held responsible for Partners achieving specific ROI targets and/or performance-based targets agreed upon under the value-based reimbursement arrangement. The individual in this role must be able to work collaboratively in a matrixed environment, have strong inter-personal skills, be organized and self-directed, and enthusiastically represent the Organization and its mission and goals.

Responsibilities:

• Develops a data-driven strategic plan related to clinical, financial, and quality goals in conjunction with each assigned Value-Based Reimbursement Partner. Uses this plan to align stakeholders within UPMC Health Plan regarding priorities for outreach and collaboration with the Partner.
• Acts as the primary liaison within UPMC Health Plan for all assigned Value-Based Reimbursement Partners.
• Coordinates with the Value-Based Reimbursement field team to ensure two-way communication between UPMC Health Plan and the community-level providers and their office staff.
• Maintains a strong understanding of quality as it relates to the shared goals of UPMC Health Plan and Value-Based Reimbursement Partners. Assists with prioritizing quality-related interventions to maximize incentive earnings for each Value-Based Reimbursement Partner.
• Coordinates among the internal UPMC Health Plan departments with respect to the necessary communications to all assigned Value-Based Reimbursement Partners and their leadership teams.
• Operationalizes the strategic plan for an assigned Partner with clear objectives and milestones and works with the Partner and internal stakeholders to achieve the performance targets and goals identified.
• In implementing the Partner-specific strategic plan, the Value-based Reimbursement Strategist works very closely with the Value-based care field-based team, assisting in the development of improvement strategies that will support primary care providers in using analytical tools, changing practice workflows, and applying continuous quality improvement methodologies to achieve targeted outcomes.
• Prepares all Value-Based Reimbursement-specific presentations and communications and manages the flow of information back to each Value-Based Reimbursement Partner with respect to other UPMC Health Plan initiatives.
• Bachelor's Degree in business, health care, or related field and 3-5 years of related experience in health care consulting, managed care especially specific to provider networks or population health management, and/or value-based reimbursement programs required.
• Master's degree in business, health care, or related field preferred.
• Analytical and organizational skills. Excellent written and verbal communication skills.
• Experience in handling and interpreting data.
• 3-5 years of clearly demonstrated experience in data analysis, interpretation, and strategic plan development.
• Demonstrated skills and experience in leadership and personnel management.
• Clinically trained and/or demonstrated experience working in outpatient clinical settings and experience presenting to physicians and health care leadership preferred.

UPMC is an Equal Opportunity Employer/Disability/Veteran