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J189462

Director Value Based Reimbursement

Allegheny Health Network

  • Company AHN
  • Home, PA
  • Provider Services
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This job is responsible for designing, directing and deploying strategic efforts across the network related to government and commercial payer programs to ensure optimal outcomes related to patient care and reimbursement.  


ESSENTIAL RESPONSIBILITIES

  • In collaboration with Sr. Leadership (CEOs, CMOs, CFOs, IQOs, etc.) of Quality, Facilities, Institutes, CIN,  assesses, develops and executes the annual plan for Pay for Value across the network. (30%)
  • Responsible for developing strategy  for AHN Value-based Reimbursement programs .to ensure optimal capture of the (est) $70 million in additional revenue.  Supports the development of managed care / CMS strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies. (20%)
  • Collaborates with VPs Contracting, Quality Analytics and CIN leadership to evaluate risk, financials and  negotiate the quality contracts for commercial payers.  Acts as an advisor related to Quality program metrics.  (15%)
  • Collaborates with Enterprise and AHN Senior Leadership from Finance;  Determines financial goals for P4V programs;  Responsible for ongoing financial estimates and evaluations;  Evaluates impact of alternative proposals for new and renewing programs. (15%)
  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. (10%)
  • SME for P4V.  Acts as advisor to senior leadership in regards to emerging trends and methodologies for P4V programs;  advises on strategies/tactics for success.  Responsible for developing and deploying education around P4V programming for Enterprise, Network, Facility and Institute Senior Executives as well as a key stakeholders for operations.  (10%)
  • Other duties as assigned.


QUALIFICATIONS:

Minimum

  • Master's Degree in a Healthcare related field
  • 5 years in Pay for Value Programming
  • 3 years with CMS Value Based Reimbursement Programs
  • 3 years in a management or leadership role
  • 1 year in an Education / Teaching / Public Speaking role​
  • Public Speaking
  • Negotiation

Preferred

  • Finance experience
  • Analytics


Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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