Director Network & Value Based Care

About the Role 

The Director, Network & Value-based Care will be responsible for leading and executing Hopscotch’s network and value-based care strategy, leveraging deep working knowledge of Medicare-focused VBC models and general network operations and collaborating cross-functionally across Population Health, Finance, and Operations to optimize contract performance.  

Specifically, this role will negotiate, execute, and manage Medicare-focused VBC contracts; set the network management strategy (e.g., whether to participate with specific payers); manage payer relationships; and bring solutions to optimize performance in VBC contracts across key contract levers, including but not limited to shared risk, carve outs, and relevant elements (e.g., attribution, quality cut points, etc.). This is an exciting opportunity to build a critical function at Hopscotch and collaborate cross-functionally to drive best-in-class results. 

What You'll Do 

• Develop deep understanding of Hopscotch’s enterprise strategy and operations and key intersection points with value-based care levers 
• Negotiate and execute network and value-based care contracts; implement contracts and manage ongoing payer relationships 
• Develop management process around payer contracting and Hopscotch's cross-functional dependencies (e.g., quality, attribution, utilization management, etc.) to ensure performance and contract requirements are met 
• Review payer data and derive insights around key levers for contract performance, including but not limited to payer market data, patient attribution, and membership growth; bring solutions to internal teams and payers based on insights 
• Analyze financial and operational implications of existing and future payer contracts, quantifying and communicating risks and opportunities to leadership 
• Identify workflow improvement opportunities to optimize value-based contract performance and see through until completion 
• Own health plan relationships with the mindset of a “business owner”; proactively identify value-add opportunities for improved performance and strategic partnerships 
• Collaborate cross-functionally with teams across Hopscotch, including Operations, Population Health, and Finance to maximize Hopscotch’s performance in value-based care contracts 
• Serve as subject matter expert on relevant payer dynamics; monitor and evaluate industry news and regulatory changes for impacts to payer strategy and reimbursement 

About You 

You would be a great fit for this position if you have 3+ years of experience in negotiating and managing value-based care agreements (e.g., shared and full risk models) in Medicare Advantage and Medicare FFS (e.g., MSSP, ACO REACH, etc.), in addition to: 

• Bachelor’s degree; graduate degree preferred 
• 5 years’ experience in network management, provider contracting, and/or managed care 
• Deep understanding of value-based contracting, including but not limited to shared risk, cash flow, revenue recognition, stop loss/reinsurance, and population health levers 
• Ability to partner with medical economics/actuarial resources and apply insights to overall value-based contracting strategy 
• Self-starter mindset capable of developing mission-critical recommendations and seeing them through in a hands-on way 
• Articulate and succinct communication skills to synthesize complex concepts, verbally and in writing, and drive results 
• Mission alignment to support an organization working to transform healthcare in rural America 

From a cultural perspective, you:   

• Create a culture of excellence, by bringing your best and encouraging the same from those around you  
• Put service to patients first and encourage the same of those around you  
• Take ownership and accountability for your work and for delivering results for patients   
• Assume the best in others and bring solutions to challenges with a focus on moving forward together  
• Show an active commitment to the team by collaborating and communicating proactively   
• Demonstrate a dedication to continuous improvement, in clinical and cultural settings   

Tags