Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Value Based Contracting Leader

📁
Director and Equivalent
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EmblemHealth
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  • Responsible for negotiating competitive and complex value-based relationships with multi-specialty groups, FQHCs, IPAs, and hospital providers.
  • Develop and utilize internal guidelines, strategic growth opportunities, market research, and financial standards to improve performance by EmblemHealth in our value-based network.
  • Lead a team of contract specialists to work cross-functionally internally and externally to standardize analyses, streamline processes, and manage performance trends to enhance overall relationships with new and existing value-based providers.

Responsibilities:

  • Identify, negotiate, and contract with new and existing strategic partners, including terms on profit sharing, downside risk, and governance requirements as required to bring value to EmblemHealth, members, and providers. 
  • Establish oversight of contract performance through defining and tracking clinical, financial, and quality metrics; maintain accountability for specific medical cost initiatives associated with productive value-based contracts.
  • Research federal, state, and competitor strategies on value-based payments to suggest contract improvements and assure compliance with all regulatory requirements.
  • Maintain PADU for value-based provider contracts and ensure team contracts within established parameters.
  • Identify deficiencies in individual and aggregate contract performance; develop and implement mitigation strategies.
  • Work with key stakeholders internally and externally to address provider concerns; develop and execute new workflows to improve internal processes impacting value-based relationships. 
  • Lead and develop team members to drive value across multiple provider types and negotiate competitive arrangements.
  • Define team objectives and measure performance to goal.
  • Build and manage VBA Contracting team, empowering their success and growth through coaching and development.
  • Establish foundational relationships with cross-functional leaders across stakeholder departments to influence roadmaps and empower team to advance work. 

Requirements:

  • Bachelor’s required; Master’s degree preferred (MBA, MPH, MA)
  • 10+ years healthcare provider experience (R)
  • Network management and contracting experience (R)
  • Experience in managing staff and processes (R)
  • Experience with value-based plans/processes (P)
  • Health plan financial operations and data analysis experience (P)
  • Excellent communication skills (verbal, written, presentation, interpersonal) with all types levels of audiences (R)
  • Ability to develop and implement performance measures and metrics (R)
  • Proficient with MS Office (Word, Excel, PowerPoint, Outlook) (R)
  • Ability to travel to meet with providers and their representatives (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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