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J216002

SVP, Risk & Value-Based Care (AHN)

Allegheny Health Network

  • Company AHN
  • Pittsburgh, PA
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

Job Summary

The Senior Vice President, Risk and Value-Based Care, reporting to the EVP and COO, Allegheny Health Network, is a critical leadership position responsible for AHN’s risk and value based care strategy. This individual leads the risk and value-based performance strategy in pursuit of the "quintuple aim" (quality, equity, affordability, patient, and health care professional experience), and in support of our value-based performance arrangements.  

In partnership with the Chief Medical Officer (CMO), the Chief Operating Officer (COO), and AHN Leadership including Population Health and Primary Care Leadership, this leader guides the success of our risk and value-based care delivery execution.  This key leader has the opportunity to partner in shaping and executing on an innovation agenda that continues to create more effective managed care and new solutions in service to Highmark Health and AHN as a national leader.  These solutions can be scaled to favorably impact Highmark’s anchor partners as well. 

Essential Responsibilities  

·       Leads the risk and value-based performance strategy in pursuit of the "quintuple aim" (quality, equity, affordability, patient, and health care professional experience), and in support of our risk and value-based performance arrangements. Partners with health plan leaders to ensure attainment of quality / Stars, affordability and total claims cost efforts, risk adjustment initiatives and outcomes. Maintains the efficient management of performance metrics across all contracts, across key value-based outcomes and works with clinical leads to determine goals and metrics driving managed care strategies. 

·       Shapes and drives critical sub-strategies around growth and risk and value-based performance. Collaborates with peers to implement strategy, business plans, operating models, and capital allocation plans consistent with the broader strategy, plans and goals of the Institutes. Monitors key initiatives and performance objectives to support the business in achieving intended results. 

·       Partners with health plan leaders to ensure attainment of quality / Stars, affordability and total medical cost efforts, risk adjustment initiatives and outcomes. Maintains the efficient management of performance metrics across all contracts and key risk and value-based outcomes. 

·       Drives value-based performance enablement: partners with the CMO, COO, and other leaders to ensure optimal awareness, alignment, support, and risk based performance of all AHN clinics and teams in support of our risk and value-based performance objectives.  

·       In partnership with the EVP and COO, identifies and champions innovation and opportunities to improve growth, value-based performance, quality, affordability outcomes for overall improved patient outcomes, and with a lens toward creating scalable insights, learnings, and solutions that can be leveraged across the broader enterprise. 

·       Leads teams to provide optimal support across analytics, clinical informatics, coaching, practice management, and optimal use of the electronic health record and technology in support of our overall objectives. On a matrix basis, ultimately ensures the full organization is supported in achieving expected outcomes. 

·       Partners closely with clinical institute and hospital leadership to leverage existing clinical pathways and digital tools supporting chronic condition management, population health and primary care expansion.  Utilizes data to inform appropriateness of stratified fee-for-service, risk and value based models. 

·       Works collaboratively with payors to determines the vision and appropriate combined strategy for metrics driving risk and Value Based Care.  Works with enterprise and AHN leaders to mutually develop KPIs and performance targets by product, segment and market.  . 

·       Leverages actuarial expertise, throughout the enterprise, and capabilities to inform AHNs approach to risk and Value Based Care, including product, segment and deal-level financial  strategy, Return on Investment prospective models, developing contract language for new metrics and products, and Performance Guarantee tracking. 

·       Works collaboratively to design, build, and maintain the analytic reporting foundation to support risk at scale, including working with Highmark to build AHN provider specific data and analytic tools to enable market-specific analyses, standardized attainment approach, advancing results maturity by deeply understanding clinical and claims cost performance across lines of business and segments for risk-bearing products. 

Education  

·       BS in Business Administration, Finance or Health Care Administration preferred 

·       Master's in Business Administration, Public Health, Healthcare Administration preferred 

·       Preferred: Professional actuarial licensure and designations, including Fellow of the Society of Actuaries or Member of the American Academy of Actuaries 

Experience Required  

·       Seven to ten years leadership experience at a senior level, preferably with a large organization in a healthcare delivery performance management environment. 

·       Experience in a complex healthcare delivery environment, with a focus on performance management, knowledge of Provider Incentive Programs and healthcare technology (HIE, EHRs). 

·       Hands on experience leading health care delivery with risk and value-based programs environment, including focus on quality, total medical cost, affordability, and risk adjustment (Stars, CMS/HHS Risk Adjustment, Accountable Care, AHCCCS quality, etc.). 

·       Pragmatic problem-solver focused on scaled solutions balancing risks with a growth imperative.

·       Experience working in a large highly matrixed organization, with proven ability to develop internal enterprise relations, and external relationships with the medical community. 

·       Demonstrated experience leading relevant functions such as health care analytics, data science, pricing, or actuarial. 

Skills Required  

·       Strong communicator able to navigate complex methodological conversations with clients toward mutually beneficial outcomes 

·       Ability to translate detailed, nuanced analytics outcomes and perspectives to non-technical audiences and executive leadership 

·       Rigor and discipline in producing most accurate analytic outcomes, and the integrity to defend methodological decisions and approaches that led to the outcomes 

·       In-depth knowledge of the health care industry, including managed care organizations, government systems, hospital systems, and integrated care systems 

Travel required - 0% to 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Never

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, 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. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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