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Montvale, New Jersey
Posted: 12-Jul-24
Location: Dallas, Texas
Salary: Open
Internal Number: 24010767
Job Summary:
Reporting to the EVP, Chief Financial Officer, the SVP Value-based Care Enablement & Employer Solutions will be responsible for providing strategic direction and leadership to the Value Based Care (VBC) business unit, portfolio and platform of services. This role is key in ensuring that all value-based care products and services offered are based on a deep working knowledge of VBC payment models and executed to advance outcomes for our customers.
Approaches value-based care as a platform service intended to scale care enablement solutions across key customer groups.
Plans, develops and implements VBC strategy and business objectives, which includes directing BSWH shared services functions, overseeing operations and driving business development opportunities.
Responsible for overall VBC operations, including financial performance, clinical excellence, comprehensive care management, utilization management, member services and business development. Collaborates with clinical and operations leadership to promote value-based care enablement and platform services throughout the system as appropriate.
As a system Senior Vice President, sets policy and objectives within a major system business unit.
Essential Functions:
- Services as the senior leader of Value Based Care enablement for BSWH
- Leads the strategic planning process and sets the vision and business model for value based care
- Identifies customer problems and translates market and customer needs into commercial solutions offerings with defensible differentiation and competitive advantages.
- Leverages cross-functional teams and external solution/service providers to develop integrated solutions and service offerings for VBC clients and customers.
- Builds and implements specific programs and services which enable success under risk-based payment models
- Understands and drives solutions/service features, functions, benefits, and pricing strategies, in collaboration with finance, analytics and operations teams.
- Client and Provider-Facing Clinical/Clinical Program Subject Matter Expert/Influencer for VBC principles and participation.
- Industry engagement across multiple external organizations.
- Consult with Operations Team to integrate solutions within the delivery system and business processes.
- Partner with the DHO on VBC platform solution roadmap.
- Seeks to realign incentives among employers, employees and providers to create mutually beneficial partnerships that unlock sustainable value for the customer and purchaser of care
- Oversees development and management of risk-based government programs such as direct contracting and ACO models as well as other programs.
- Partners effectively with the BSW Health Plan to integrate services driving value and efficiency for the company and VBC clients and seeking to develop distinctive and integrated health insurance products for key customer groups.
Qualifications:
- Experiencing supporting value-based care growth & strategy and the evolution of product, services, and technology.
- Demonstrated expertise in value based care - improving outcomes while managing total cost of care - in a population segment specific manner
- Demonstrated expertise in Medicare Advantage
- Deep understanding of the broker space and role with large group self-insured employers
- Ability to think with an enterprise mindset and to continuously challenge the status quo.
- Demonstrated ability to motivate people and teams while raising performance levels year over year.
- Strong presentation skills with the ability to present on large platforms.
Key areas of responsibility:
- 65+ Strategy
- DWE - direct with employer
- Network and distribution
o CINs
o Channel partners (e.g. Centivo, HER)
- P&L responsibility for risk contracts (ACO and risk pools)
- Care management
Overarching Goals:
- Become the Employers Choice in Texas for high-value health care by re-activating value based care through embedding customer centricity and new products and services into care enablement models designed for the Customer and commercially available for B2B customer channels.
- Achieve breakeven or better performance on Medicare Advantage line of business with demonstrably better outcomes as compared to unmanaged
- In partnership with the health plan CEO, create a high trust team and culture among the health plan and VBC leaders
- In partnership with the health plan CEO and system Chief Products Officer, seek to develop distinctive, integrated and customer centric insurance offerings
Specific deliverables:
- Achieve 65+ OKRs
- Develop go-to-market strategy for key products and services for DWE clients
- Develop a strategy for broker and employer engagement in the greater DFW market
- Develop strategy and plan to achieve the necessary network configuration and market reach for the BSWH CIN across key markets in Texas
Minimum Requirements:
- Bachelor's Degree
- 10 years of experience