Program Manager Population Health and Value Based Care

M Health Fairview has an immediate opening for a Program Manager, Population Health and Value-Based Care to support the Fairview Partners (FVP) team.

This is a 1.0 FTE (80 hours per two week pay period), salaried/exempt opening.

Directs and coordinates Fairview Partners value-based care projects and programs advancing the ability to meet the quadruple aim: improve patient/resident experience, improve population health, reduce costs and improve provider experience.

Helps optimize performance for value-aligned incentives, alternative payment models, and other population health metrics for more reliable, equitable, and high-quality care. Initiatives will cover a broad range of content including but not limited to alternative payment models, network performance, provider alignment and payer performance.

Works collaboratively with key supporting partners including data analytics, payer relations (product development/product management, contracting), and quality on initiatives.

This position reports to the Vice President of Fairview Partners.

Job Expectations:

Population Health:

• Assist with the identification, analysis and ongoing reporting of quality, cost savings, and revenue-enhancing opportunities.
• Provides data analysis for financial and clinical utilization, quality monitoring and performance improvement as required to meet regulatory requirements and Fairview Partners priorities.
• Collaborates with department colleagues and system partners to provide Fairview Partners data to support population health priorities.
• Maintains knowledge of and complies with alternative payment models and best practices around value-based care transformation.
• Directs the planning, implementation and evaluation of value-based care outcomes using evidence-based and innovative approaches to improve population health and total cost of care.

Reporting & Data:

• Produces monthly enrollment reporting, which includes monitoring revenue and reporting enrollment to other entities of the program.
• Oversees Fairview Partners program reporting in Power BI in partnership with system data analytics team and Fairview Partners Care Management.
• Collaborates with Fairview Partners clinical staff to optimize Epic reporting and data gathering to support care coordination priorities and workflows.
• Receives and disseminates all payer reporting to Fairview Partners staff as appropriate.

Budgeting & Finance:

• Monitors the monthly financial reports provided by the health plans and corporate accounting.
• Identifies, recommends and implements changes that will improve productivity and/or financial performance.
• Prepares/assists in the financial forecast and monitors program/project health for monthly variances to plan.
• Works with the Vice President and Director of Care Management to prepare annual budget forecast and targets.
• Audits annual health plan settlements and prepares financial distributions to the participating partners of the Fairview Partners program.
• Provides analytical support for health plan contract proposals and actively participates in payer negotiations.

Required

Education

Bachelor’s degree or higher in a health-related field such as Business Administration, Healthcare Administration, Nursing or Public Health.

Experience

Minimum 5 years of experience required in relevant field, including health care, quality and process improvement, health care analytics, payer relations and contracting.

3-5 years leadership experience.

Other

Strong organizational skills demonstrated analysis and problem-solving skills.

Knowledge of data and analytics software including Excel and Power BI.

Experience with and knowledge of advanced alternative payment models.

Ability to work independently with strong vision and deliverables aligned with strategic goals.

Excellent oral and communications skills.

Demonstrated ability to establish and maintain working relationships with peers and stakeholders at all levels of the organization.

Great understanding of the organization, organizational dynamics, and clinical operations.

Preferred

Education

Master’s degree or higher in a health-related field such as Business Administration, Healthcare Administration, Nursing or Public Health.

Experience

Experience with and knowledge of advanced alternative payment models, including Next Generation ACO, Minnesota Community Measures (MNCM), Quality Payment Programs (QPP), Bundled Payment programs, Medicare Advantage, and other value-aligned initiatives.

Expertise in population health, quality, or directly in primary care – knowledge of practices that support health disparities, variations in the population serviced, and provider alignment initiatives.

Background or experience in clinical operations and quality.

Previous experience with payer relationships/product development around value-aligned specifications

A track record with clinical programs and models of care. Experience with care management and at-risk patient populations.

Knowledge of accreditation and healthcare regulations related to value-based care programs at a state and national level.

Knowledge and experience with providers and clinically integrated network performance and infrastructure.

License/Certification/Registration

Formal project management or improvement methodology certification.