AVP, Primary Care Physician Incentive Programs

We have an exciting opportunity for an AVP, Primary Care Physician Incentive Programs to join our leadership team at the UPMC Health Plan. As AVP, you will lead the management of the Health Plan's Primary Care Physician Incentive Programs. This is an exciting opportunity to oversee a cutting-edge reimbursement model.

Under the supervision of the Vice President, Contracting, Reimbursement, and Value-Based Payments, the AVP is responsible for the relationship with all Shared Savings Partners as well as the integrity of the data provided to Shared Savings and Pay-for-Performance program participants. The ideal candidate will have prior experience with physician contracting in managed care.

This role is based in Pittsburgh, PA and will require regular onsite presence.

Responsibilities:

• Responsible for the creation and on-going management of all primary care physician incentive programs.

• Establish a cohesive strategy across all primary care-based programs that create a roadmap for each type of practice to progress within the incentive structure and maximize both their earnings and the Health Plan's quality results.

• Oversee the Senior Director and Director responsible for executing all daily program operations and managing the data teams for each ~~~ conjunction with the VP, develop forward-looking strategy to incorporate Shared Savings or other Value-Based Reimbursement methodologies into all future Health Plan contracting strategies.

• Act as the internal representative when primary care-related value-based presentations are requested and draft responses when Shared Savings elements are necessary to incorporate into RFPs or other bids.

• Develop the future strategy for Shared Savings and Pay-for-Performance programs including creation of multiple iterations of each program design and incorporation of risk elements in order to meet Health Plan and provider goals and objectives.

• Develop and report on both internal and external metrics of success related to the overall Shared Savings and Pay-for-Performance Programs, including how each practice is performing individually.

• Strategically identify new potential Shared Savings Partners based on their pay-for-performance results and overall engagement; fully incorporate these provider groups into the program.

• Draft all modifications to the Shared Savings amendments each program year and manage the incorporation of any changes to the agreements and distribution of the agreements to the Shared Savings Partners.

• Develop and oversee dedicated teams to support each Shared Savings Partner and large Pay-for-Performance participant and provide each with a tailored approach to reporting in order to further progress and identify Partners ready for the next level of the primary care incentive program continuum.

• Ensure continual alignment between the Pay-for-Performance and Shared Savings Programs and other Health Plan Value Based Reimbursement strategies, such as Bundled Payments.

• Manage relationships with high-profile Shared Savings Partners to ensure continual growth of the partnership.

• Bachelor's Degree required

• 5-10 years of experience in Value-Based Contracting.

• Experience in physician contracting preferred.

UPMC is an Equal Opportunity Employer/Disability/Veteran