Job Summary:

The Hospital Value-Based Provider Programs Manager – Markets is responsible for the development, implementation, oversight, and performance of value-based payment initiatives within the market. This position serves as the primary market lead for hospital and provider value-based payment programs, ensuring successful contract implementation, achievement of quality and financial objectives, and alignment with market-specific strategic priorities. This role is accountable for driving provider engagement, monitoring program performance, supporting quality improvement efforts, and managing hospital value-based payment arrangements that return quality withhold funds to the state health plan through achievement of contractual quality measures and performance targets. In addition to value-based payment initiatives, this position oversees strategic market programs including provider performance initiatives designed to improve health outcomes, provider experience, and operational efficiency. This position must reside in Nevada.


Essential Functions:

• Lead the implementation, monitoring, and optimization of hospital value-based payment programs, ensuring contractual performance expectations, quality outcomes, and financial targets are achieved.
• Develop and execute strategies to maximize quality withhold performance and return quality incentive payments to the market health plan through provider engagement, education, performance monitoring, and corrective action planning.
• Serve as the market subject matter expert for hospital value-based payment programs, providing leadership and operational guidance to internal stakeholders and contracted provider organizations.
• Oversee additional programs, including provider participation, regulatory compliance, stakeholder engagement, reporting, and program performance monitoring.
• Collaborate with provider organizations and internal business partners to identify opportunities for care gap closure, improved quality outcomes, appropriate utilization, and enhanced member experience.
• Monitor provider performance against contractual quality metrics and facilitate action plans designed to improve results and support achievement of program goals.
• Participate in key committees, subcommittees, and work groups as necessary.
• Maintain strong internal and external relationships with key business partners.
• Manage multiple projects, collect and analyze data, and disseminate information to appropriate departments as necessary.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in Business Administration, Healthcare Administration, Public Health, Finance, Nursing, or related field
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Five (5) years of experience in value-based reimbursement/payment design, methodologies and/or VBR contracting, provider contracting, provider performance, managed care operations, population health, or healthcare quality required
• Experience working with hospitals, health systems, physician organizations, or Accountalbe Care Organizations (ACO) required
• Medicaid Managed Care experience is strongly preferred
• Experience leading market-based provider incentive, quality, or value-based payment programs preferred
• Knowledge of state healthcare market, provider networks, and Medicaid programs preferred
• Demonstrated experience building collaborative relationships with providers, hospitals, and healthcare system stakeholders to achieve quality and financial performance goals preferred

Competencies, Knowledge and Skills:

• Proficient with Microsoft Office to include Word, Excel and PowerPoint
• Excellent written and verbal communications skills
• High level of analytical/problem solving skills
• Ability to develop, prioritize and accomplish goals
• Demonstrates excellent analysis and reporting skills
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Understanding of healthcare payer industry
• Effective problem-solving skills with attention to detail
• Ability to work independently and within a team
• Excellent collaboration skills
• Ability to create and maintain excellent working relationships

Licensure and Certification:

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Up to 25% (regular) travel based on the needs of the department may be required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.