Director - Value Based Programs

The Value-Based Purchasing & Care Director is accountable for the transformation and performance of value-based programs with large provider systems contracting with the health plan. This leader has direct accountability for the design and development of value-based program strategies with provider system leadership - including the execution, oversight, and sustainment of high performance in the areas of healthcare quality, organizational cost, and patient experience.

 

This role is pivotal in positioning and differentiating the health plan to lead the market in the adoption and advancement of value-based care and alignment of payer and provider incentives, contributing to the organization's success in HEDIS, STARS, risk adjustment, and medical cost management. This position will work externally with executive leaders in Presbyterian's provider network to educate and prepare provider systems to engage in value-based payment models and internally with health plan finance, population health, clinical operations, medical economics, analytics, and other senior leaders.

 

This job is intended to be conducted in the state of New Mexico.

• Bachelors degree required.
• Masters degree in business administration or healthcare management preferred.
• Three years of healthcare experience.
• Experience working with provider systems administering complex contracts and quality outcomes preferred.
• Demonstrates strong communication, influencing, strategic, analytical, critical thinking and creative solutioning skills.

• Serves as the main point of contact with direct responsibility for their portfolio of key provider systems in a value-based program.
• Leads the deployment, sustainment, and continuous development of the health plan's value-based programs center of excellence model with provider systems.
• Partners with provider systems to achieve quality of care, financial stewardship, and patient experience value-based program targets.
• Leads joint operating committees with provider system leadership - using data-driven insights, monitoring tools, and performance measures e.g. capitated financial performance, quality scores, risk adjustment, and patient experience metrics.
• Identifies trends, industry best practices, and local needs to guide the development and implementation of interventions, strategies, and solutions to improve provider and provider system performance under value-based programs.
• Sets annual value-based program targets for each provider system in conjunction with senior leadership in alignment with organizational goals.
• Conducts market assessments to identify growth opportunities and provider system candidates for inclusion in the health plan's value-based programs.
  
  

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

 

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

 

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

 

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

 

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $69.20/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.