Director Value Based Contracts - CINQCARE

Why CINQCARE is Different

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to Black and Brown communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our Family Members’ race, culture, and environment is critical to delivering improved health outcomes. By empowering Family Members, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

About You

• Bachelor Degree or equivalent work experience in Business Administration, Healthcare 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment.
• Advanced proficiency with Healthcare, Managed Care Organization, or Managed Behavioral Healthcare.
• Proficient with MS Office suite (Word, Excel, PowerPoint).
• Entrepreneurial spirit with a demonstrated ability to work collaboratively and influence others.
• Strong verbal and written communication skills adapted to all levels of the organization both internal and external.
• Experience in strategic positioning, developing, executing and adhering to business plans.
• Able to read and comprehend complex written materials as well as spoken information.
• Able to establish and maintain effective working relationships with internal and external stakeholders.
• Demonstrated skills and experience in collaborative, strategic and analytical thinking.
• Proven experience uncovering obstacles and implementing an innovative troubleshooting approach.
• Strong interpersonal skills and demonstrated ability to take leadership simultaneously on multiple projects.
• Proven ability to manage large-scale projects in a fast-paced, deadline-driven, and highly collaborative environment.
• Comfortable in a technically complex environment.
• Willingness to make timely decisions.
• Sound, accurate and independent judgment.
• Ability to travel

About the Job

The Director, Value Based Contracts will report to the SVP Healthcare Economics and Analytics and will oversee the full life cycle of Payer Risk Contracts and Provider Value Based Contracts, including support for new business. To do this, the incumbent is responsible for daily decision-making, anticipating challenges and future needs. The position must be able to understand the Company’s goals and desired outcomes in relation to value-based contracts. As such, the ideal candidate for this role has proven experience leading cross-functional initiatives, managing a multi-discipline workforce.

Essential Functions

• Primary Lead - Risk & MSO Contracts + Contract Life Cycle
• Primary Lead - Budget
• Primary Lead - Pro Formas
• Oversee - Contract Administrative Support
• Oversee - Provider Contract Support
• Support - Networks

Deliverables:

Establish the department's strategic vision, objectives, and policies & procedures.

Develop and implement a departmental strategy aligned with business goals and requirements.

Set and enforce andards for contracting in order to meet organizational objectives.

Lead all aspects of assigned contracting activities, including access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management.

Oversee the coordination and negotiation for contracting, safeguarding contract and credentialing compliance.

Negotiate competitive and complex, value-based contractual relationships with providers according to pre-determined internal guidelines and financial standards.

Build relationships with value-based contracting groups and their associated teams.

Perform, as requested, periodic analyses of the provider network from a cost, coverage, and growth perspective.

Lead efforts and accept responsibility for the financial and quality of performance of value-based contract.

Collaborate with value-based contracting provider groups to achieve the quality performance benchmarks established in the contract.

Lead change management to ensure a successful practice performance under value-based contracts.

Design, deploy, and provide ongoing monitoring that addresses provider performance gaps for quality metrics and benchmarks related to value-based care initiatives.

Establish oversight, monitoring and management processes aimed at optimizing results, including defining the underlying metrics of value-based programs and alternative payments models.

Support expansion of value-based contracted provider network, exclusivity arrangements and network opportunities, while maintaining relationships with providers and external partners / resources.

Provide leadership in evaluating opportunities to expand, enhance or change the alternative network payment model to meet company goals and manage networks costs & provider contracts.

Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.

Conduct periodic review of alternative payment models and value-based provider contracting rates to ensure strategic focus is on target with overall company strategy.

Partner with leadership to ensure process change needs are identified and developed, and that related ongoing training is available.

Assist with key network development strategies.

CINQCARE provides all employees working an average of 30+ hours/week with the option to enroll in healthcare benefits. The cost of healthcare is shared between the company and the employee.

The working environment and physical requirements of the job include:

This position requires both in-home and office-based work. In-office work is performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace.

In this position you will need an ability to travel, the ability to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 5 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.