JR114186 Value Based and Rate Governance Manager

Responsible for supporting Payment Innovation value-based program operations, including contract development and maintenance, process development and management, market support, communications, training, requirement development, and user testing. Supports markets in fee schedule analysis and development including state and regulatory updates.

Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Pulse Point office locations in Texas, Colorado, and California.

How will you make an impact:

• Supports one or more operational components for one or multiple value-based programs.

• Provides support for business fundamental management of existing programs, enhancements to existing programs, and new program roll-out.

• Performs operational vetting end to end to identify impacts for new programs as well as existing program changes.

• Supports market contracting and resolves issues.

• Develops and manages internal and external communications and associated legal and regulatory approvals.

• Develops and manages contract material and schedule for value-based program.

• Writes business requirements.

• Works with other business partners to guide and support solution development, pilot, and solution launch activities.

• Develops and maintains process documentation.

• May manage small-scale program implementation efforts.

Minimum requirements:

• Requires BA/BS in business or related field and a minimum of 2 years health insurance industry experience; and 3 years program/project management experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• MBA degree and PMP certification strongly preferred.

• Experience with value-based agreements preferred.

• Fee for service rate rationalization or analysis experience preferred.