Value Based Reimbursement Strategist

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 95,000 - 135,000; Full time

Job summary

UPMC Health Plan seeks a Value-Based Reimbursement Strategist to work with primary care leadership to analyze performance, identify improvement opportunities, and drive value-based care and ROI. You will develop and implement value creation strategies for Partner groups, coordinate with internal stakeholders, and support clinical and financial goals to improve care delivery.

This Hybrid role requires three in-office days per week in Downtown Pittsburgh and a passion for turning data into better

Qualifications

• Experience analyzing performance data to identify opportunities for improvement.
• Ability to develop strategic plans with measurable clinical/financial outcomes.
• Knowledge of value-based reimbursement concepts in primary care.
• Stakeholder coordination across multi-team environments.

Responsibilities

• Develops data-driven strategic plans for clinical, financial, and quality goals with Partners.
• Acts as primary liaison between UPMC Health Plan and Value-Based Reimbursement Partners.
• Coordinates with field teams to ensure two-way communication with providers and staff.
• Prioritizes quality-related interventions to maximize incentive earnings for Partners.
• Operationalizes the strategic plan with milestones and collaborates to hit targets.

Skills

Data analysis

Strategic planning

Stakeholder management

Healthcare reimbursement

Tools

Excel

SQL

Power BI

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.

Hybrid and requires 3 days per week in office in Downtown Pittsburgh

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.