Program Manager - Value Based Care - FT - Days - MHS

Value Based Care Program Manager

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

The Value Based Care Program Manager is responsible for the successful planning and execution of key strategic initiatives and activities that enable the rapid advancement of high-performance value-based care operations. Partners closely with operations, analytics, and clinical leadership, including all areas of population health operations including, but not limited to, care management, quality, utilization management, network strategy, patient engagement, technology, performance monitoring, clinical effectiveness, pharmacy, social work, post-acute partners, community-based organizations and more. Develops tactics to meet program goals and metrics and facilitates key leadership meetings to collaborate with community partners, communicating and holding teams accountable to progress against program objectives and goals.

Responsibilities :

• Supports strategic planning for evolving value-based care initiatives consistent with organizational priorities and monitor key performance indicators to deliver best in class programs.
• Partners with key organizational and community stakeholders to establish and integrate programs, networks, or services necessary to successfully manage risk contracts through full implementation, pilot or management.
• Translates strategy into operational tactics through focused efforts and actions that will have the greatest strategic impact, including the education of management and staff on program relevancy in the industry.
• Provides transitional care management and coordination of care for patients recently discharged from the acute care setting in collaboration with patients, family members, post-acute providers, internal and external healthcare organizations / team members and post-acute facilities.
• Conducts initial health risk assessment, identifies, and manages health and safety risks including social determinants of health, functional status, cognitive ability, medication clarification, and health literacy.
• Develops a patient-centered care plan to optimize disease management. As appropriate, discuss plans of care with patients and families.
• Assesses patient / caregiver capacity and willingness to participate in care model program.
• Ensures compliance with regulations and governing laws for contracted payers including Federal and state governmental payers.
• Reviews, evaluates and summarizes rules, regulations and contracts relating to all current and proposed value-based programs.
• Leads and develops content for key committees that oversee performance and projects and programs supporting the value-based care portfolio, including interfacing with external partners (payers, physician, post-acute and / or community-based providers, etc.).
• Creates management processes to drive accountability on key metrics and develops new metrics to guide strategic and operational decision-making.
• Coordinates Single Payor Agreements (SPA) through the Innovative Placement Program, for eligible patients as dictated by the policies of the organization.
• Partners closely with operations, analytics, and clinical leadership, including all areas of population health operations (not limited to : care management, quality, utilization management, network strategy, patient engagement, technology, performance monitoring, etc.) to assure all are informed, working as one unified organization and well aware of deadlines, requirements and their role within the value-based program infrastructure.
• Coordinates with analytics team to develop reporting tools to evaluate and develop actionable reports to communicate quality, risk, and cost efficiency opportunities for key stakeholders.
• Identifies, develops and / or manages care transformation solutions drawing from national best practices, analytics, personal expertise, and creativity to deliver value-based programs.
• Provides support for quality improvement initiatives utilizing clinical knowledge and expertise. Identifies potential quality and safety issues pertaining to patient care and leading clinical quality improvement projects that are supported by evidence based best practice. Partners with leadership, key stakeholders and / or clinical teams to identify, analyze, monitor, and improve key performance indicators. Works with leaders and / or key stakeholders on defining appropriate process and patient outcome benchmarks, data capture processes, and dashboards. Assists in the coordination and collaboration with stakeholders, multidisciplinary teams, and internal and external customers to create collaborative work relationships that drive improved patients' outcomes that lead to performance improvement in quality and total cost of care in a timely and effective manner.
• Responsible for being a care transformation change agent through strong partnerships and collaboration with providers, clinicians, and all key stakeholders. Provides coaching and oversight to key team members for identified areas of operation. Aligns critical physician and / or post-acute partnerships necessary in such programs by creating a shared vision and fostering a relationship characterized by open communication and trust.

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