Director, Value Based Care Performance and Operations

Sentara
life insurance, vision insurance, sick time
United States, Virginia, Virginia Beach
Jan 04, 2025
City/State Virginia Beach, VA Overview Work Shift First (Days) (United States of America) Sentara Health is seeking to hire a qualified individual to join our team as Director, Value Based Care Performance and Operations. Position Status: Full-time, Day Shift Position Location: This position is in person. Standard Working Hours: 8:00AM to 5:00PM (ET). Minimum Requirements: Bachelor's Degree required. 5+ years Healthcare Finance, Physician reimbursement, total cost of care analysis required. 5+ years MSSP, ACO Quality reporting and data analytics pop health management required. Expectations for this Role: Sentara Health is seeking Director, Value Based Care Performance and Operations. This director will be responsible for clinical informatics, growing our clinical programs through technology, reporting aspects, operations oversight and more. Sentara Health Overview Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020). Mission, Purpose, and Values Mission - We improve health every day. Purpose - Sentara exists to be the trusted partner to individuals and the community in their journey to health and well-being. Values - People, Quality, Patient Safety, Service, and Integrity. Sentara Healthcare Commitments Sentara has made a commitment to its colleagues, patients, and members to: Always keep you safe. Always treat you with dignity, respect, and compassion. Always listen and respond to you. Always keep you informed and involved. Always work together as a team to provide you with quality healthcare. Diversity and Inclusion at Sentara Our vision is that everyone brings the strengths that come with diversity to work with them every day. When we are achieving our vision, we have team members that feel they belong and can be their authentic selves, and our workforce is reflective of the communities we serve. We are realizing this vision through our Diversity and Inclusion strategy, which has three pillars: A diverse and talented workforce, an inclusive and supportive workplace, and outreach and engagement with our community. We have made remarkable strides in these areas over the past several years and, as our world continues to evolve, we know our work is never done. Our strategies focus on bothstructural inclusion, which looks at our organizational structures, processes, and practices; as well asbehavioral inclusion, which evaluates our mindsets, skillsets, and relationships. Together, these strategies are moving our organization forward in an environment that fosters a culture of mutual respect and belonging for all. Please visit the link below to learn more about Sentara's commitment to diversity and inclusion: https://www.sentara.com/aboutus/mission-vision-and-values/diversity.aspx Sentara Benefits As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to: Medical, Dental, and Vision Insurance Paid Annual Leave, Sick Leave Flexible Spending Accounts Retirement funds with matching contribution Supplemental insurance policies, including legal, Life Insurance and AD&D among others. Work Perks program includes discounted movie and theme park tickets among other great deals. Opportunities for further advancement within our organization Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within avibrant, creative, and highly productive workplace. For information about our employee benefits, please visit:Benefits - Sentara (sentaracareers.com) Join our team!We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth! Please Note: Yearly Flu Vaccination are required for employment. #indeed, #LI-AB1 Key words: Director, Analytics, Value Based Care Job Summary Job Profile SummaryReporting directly to the Vice President of Population Health, the Director of Value Based Care Business Performance and Operations will lead a team that creates, develops, and manages the reporting and business analysis to support regulatory, contractual, and operational requirements; and decision making of a large Clinically Integrated Network of physicians and providers. This Director will be responsible for leading a team to execute the vision and roadmap set by the V.P. of Population Health and the operational analytics and reporting necessary to monitor and sustain that improvement of outcomes across the network. The Director will be responsible for the VBC Performance and Operations team as they execute specific actions that drive provider engagement and performance across the network. The Director will champion the use of data insights and analytics to drive Population Health Management decision-making for the Network. The Director will develop business intelligence for the financial performance of the network as a whole, as well as by value-based contract program. The Director will ensure appropriate data is leveraged into insights and reporting around Quality, Total Cost of Care Management, Patient Experience, and Risk coding. The Director will partner with the SQCN Board of Directors and Committees, the SQCN/SACO Medical Directors, and division staff to support operations, understand productivity and drive performance. Additionally, they provide support and insights to Payer and Enterprise Analytics teams. They will also assist in short- and long-range strategic planning for the Network and in developing the business competencies and relationships that support the growth and advancement of SQCN as an innovative leader in value based care. In this dynamic position, The Director, Value Based Care Business Performance and Operations will be a key liaison in working with Sentara Health IT, Clinical Informatics, and Analytics to support all aspects for regulatory, contractual, and leadership reporting and operations. This director will need to facilitate strong relationships with physician practices as well as, internal leaders across Information Technology, Clinical Informatics, and System Analytics to facilitate the tools resources and timely reporting to various payors. Additionally, this role will develop reporting and analytics to support informed leadership decision making for care management and network leadership. Sentara Quality Care Network (SQCN), is a clinically integrated network, led by Sentara Health comprised of 3,700 employed and independent physicians and providers across Virgnia and northern North Carolina. Our 3,700 clinicians in SQCN are in shared risk agreements which cover over 250,000 lives. Included in these 250,000 lives are 67,000 lives served by Sentara ACO (SACO) in an MSSP ACO contract with CMS. PRIMARY RESPONSIBILITIES: Develops and maintains the Practice-Provider Data and has oversight of data quality and integrity, Network architecture visualizations and downstream reporting of provider rosters. Provides Agenda development support and Content creation for SQCN/SACO Committees, such as Finance, PSC/Membership, CPC, and Physician Leadership meetings. Provides oversight for the content development of reporting that supports various Network stakeholders, such as Performance Reviews for Participant Practices, Performance Reviews for Employers, business reporting used by internal Sentara Stakeholders and performance data for SQCN subcontractor entities. Participates in the range of Division Leadership working and strategic planning meetings. Serves as a strategic thought partner to provide input into strategies through analytics and insights. Provides oversight of VBC Program financial reporting and analytics, including revenue and expenditure accounting, distribution models and payments, physician payments and communication of all of the above to the appropriate Network stakeholders. Promotes the use of SQCN designated data and analytics systems consistent with the expectations of the CIN for and participant practice competency development. Provides direction for VBC Program Performance reporting and analytics, for all Lines of Business, including quality, total cost of care, coding and risk, and patient experience performance. Develops insights into improvement opportunities and identifies actionable steps to address those opportunities. Provides direction for VBC Performance reporting and Analytics that cover additional important Pop Health Management domains, such as post-acute care, end of life care, care management panels and staff productivity. Provides direction for the development of Population Health Management Platform reporting tools (registries, metrics, operational reports) that facilitates operations for staff and participant practices, such as aggregated ADT information, top level and nuanced patient risk stratification, disease specific reporting. Responsible for creating and maintaining a system that gives feedback to providers individually and collectively regarding care effectiveness of individual providers, practices TINS and the Network as a whole. Develops methods for communication and sharing of data and the creation of a systematic and fair approach to transparency of performance (individuals, group practices, specialties, SQCN overall) across the network. Leads Network in regulatory reporting including the MSSP program, APP and MIPS pathways, and Stark and Anti-kickback compliance. Develops team competencies in data sets from various 3rd party platforms (payers, CMS, EHRs, HIEs, vendors) that contain Network data, metrics and analysis. Leverages these data sets to develop insights that support operations and drive performance. Preferred Certifications: Clinical Informatics, SQL, Tableau, Epic, Advanced Practice Provider, Nursing, Informatics, Professional in Healthcare Quality Qualifications: BLD - Bachelor's Level Degree (Required), MLD - Master's Level Degree Healthcare Finance, Physician Reimbursement, Total Cost of Care Analysis. This leader must be well versed in MSSP ACO reporting and be capable of leading the strategic and executional performance reporting for an MSSP ACO comprised of employed and independent practices on various EHR systems. This leader will need to be well versed in quality metrics in value-based care contracts, and be knowledgeable on Medicare, Medicaid, Commercial, Fee For Service, and Value based reimbursement; as well as the quality reporting that supports these mechanisms to payors., MSSP ACO Quality Reporting and Data Analytics Population Health management, managed care or related field., Preferred: Actuarial, Value Based Care, Total Cost of care Analysis, Clinical informatics Skills Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission "to improve health every day," this is a tobacco-free environment.