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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in developing and implementing Value-Based Payment (VBP) strategies and models, with a strong focus on provider reimbursement, financial modeling, and performance analysis in managed care operations. Proven ability to collaborate across teams and communicate effectively with stakeholders to enhance provider relationships and operational efficiency.
Highest-signal resume keywords
Value-Based Payment (VBP) StrategiesManaged Care OperationsFinancial ModelingPerformance AnalysisProvider Reimbursement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Value-Based Payment Model DesignData AnalysisPerformance Metrics DevelopmentCost Reduction StrategiesBenchmark EstablishmentUtilization ManagementIncentive MethodologiesRisk MethodologiesOperational Gap ResolutionMatrixed Environment Experience
Soft Skills
Interpersonal SkillsOrganizational SkillsCommunication SkillsPresentation SkillsProblem-Solving Skills
Industry Keywords
Medicaid Managed CarePay-For-PerformanceBundled PaymentsAccountable CareShared SavingsShared-Risk ArrangementsBehavioral HealthMaternity CareSocial Determinants of HealthValue-Based Care
About the role
Key responsibilities & impact- Support successful value-based provider relationships, focusing on provider experience and path-to-value goals
- Lead end-to-end operational support of specialty Medicaid value-based payment models
- Develop innovative VBP models for behavioral health, maternity, specialty providers, and social determinants of health
- Create glide paths to move providers from volume to value
- Align new VBP model development with segment roadmaps, Medicaid contractual requirements, and RFP commitments
- Analyze financial, utilization, and performance data to identify quality improvement and total-cost-of-care reduction opportunities
- Create VBP payment strategies and model designs, including payment logic, performance metrics, benchmarks, and financial terms
- Design and contribute to provider reporting packages explaining overall and detailed performance
- Partner with finance on impact analysis and modeling for new VBP models
- Collaborate with matrixed teams to operationalize and roll out new VBP models
- Identify and help resolve operational gaps
- Monitor VBP model performance KPIs and enhance model design using feedback and performance data
- Translate strategy into models that can be piloted and scaled across markets
Requirements
What you’ll need- Bachelor's degree
- Minimum five (5) years of experience in managed care operations, provider reimbursement and analytics, and value-based care
- Two (2) or more years of direct experience designing, structuring, and implementing value-based payment (VBP) strategies and models for specialty providers
- Experience with pay-for-performance, bundled payments, accountable care, shared savings, and shared-risk arrangements
- Experience using financial, utilization, quality, and performance data to design and model VBP arrangements
- Experience establishing baselines and benchmarks, identifying cost and utilization opportunities, setting performance targets, and developing incentive, shared-savings, and risk methodologies
- Experience operating in a matrixed environment
- Expertise in Medicare and/or Medicaid managed care
- Ability to identify, structure, and solve complex business problems
- Excellent interpersonal, organizational, written, and oral communication and presentation skills
- Proven experience writing and delivering presentations to members of the management team
- Preferred: Master's degree
- Preferred: Expertise in VBP financial modeling and impact analysis
- Preferred: Direct experience working for a Medicaid managed care health plan
- Ability to work remotely from a dedicated space without ongoing interruptions
- Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Remote work arrangement
- Up to 10% travel for onsite meetings
- Dedicated home workspace and internet requirements supporting remote work