"Alerted.org

Job Summary

The Corporate Director, Payment Innovation has responsibility for supporting the company in Value-Based Care payment models. This position will work in a matrixed model with other departments such as Market Operations, Physician and Clinical Services, Managed Care, Strategy and Business Development, Legal, and Compliance. This position will serve as a knowledge leader in quality as it relates to value-based care to support the company and its market leaders as they execute in developing and expanding value based care models. .

Essential Duties and Responsibilities

+ Support operations, promote development, and maintain industry knowledge related to:

+ Accountable Care Organizations (ACOs)

+ Clinically Integrated Networks (CINs)

+ Other Value Based Care models as applicable

+ Supports ~30 Continuum of Care Coordinators (CCCs) in CHS markets in operational needs, including but not limited to post-acute collaborative network management, case management collaborations, utilization, and quality reviews, contract management, data and reporting, training and coaching. Compile reporting related to CCCs performance.

+ Manage annual and ad hoc regulatory reporting submission requirements related to quality in value based program participation. In-depth reporting and analysis of opportunities and risks related to clinical quality reporting requirements. Provide and oversee planned and ad hoc training and recommendations for corrective actions for all participants and reporting teams.

+ Lead annual ACO GRPO Quality Audit through coordination of data collection and data submission to CMS. Assists quality teams in performing chart reviews for quality metrics and GPRO reporting. Stay abreast of all requirements for the ACO Quality reporting and updates for eCQM requirements.

+ Serves as a subject matter expert for ACO Quality. Possess deep understanding of the ACO Quality Metrics Reporting.

+ Supports and collaborates with internal departments with regards to data entry and submission of MIPS reporting requirements. Suggests and implement process improvements to enhance data entry efficiency, accuracy, and overall MIPS reporting performance.

+ Assist in compliance activities related to ACO operations. This includes ACO beneficiary notices, maintenance of policies related to post-acute preferred provider lists, and internal as well as external ACO quality audits.

+ Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre-and post-acute care.

+ Responsible for collaborating with market stakeholders on opportunity areas for models supported to maximize financial and quality performance.

+ Actively engage with peers and industry experts to determine potential new value based care models the Company should consider.

+ Ability to perform multiple activities, meet deadlines, solve problems, utilize resources, make independent decisions, and work well in a team-based environment. Hands-on individual with great attention to detail, high personal accountability, and strong drive to develop him/herself while learning business model.

Qualifications

Required Education:

+ BS/BA in clinical degree (e.g. social work/nursing/physician assistant). Relevant experience can be substituted if non-clinical degree.

Preferred Education:

+ Masters degree in relevant field strongly preferred.

Required Experience:

+ A minimum of two years of strong clinical/healthcare. Current working knowledge of discharge planning, utilization management, case management and disease management. Experience with clinical quality reporting required. A minimum of 5 years of combined relevant experience.

Preferred Experience:

+ Prior experience in alternative payment models, hospital or health plan quality performance, or equivalent experience preferred. An understanding of health plan/hospital and physician managed care quality methodologies and terminology is preferred. Supervisory and project leadership experience is preferred.

Computer Skills Required:

Proficient in Microsoft Office products such as Word, Excel, PowerPoint.

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.