The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a SR Business Specialist. This Value Based Purchasing Manager position is responsible for developing AHCCCS Value Based Purchasing (VBP) strategies and will serve as the agency’s subject matter expert for VBP financial management in the Division of Health Care Management. In this role, the position will collaborate with cross-functional teams, including actuarial, clinical, financial, operational, rates and reimbursement, and policy areas, to advance delivery system and provider payment initiatives that improve health outcomes while bending the cost curve.
The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona, unless an exception is properly authorized in advance.
Major duties and responsibilities include but are not limited to:
• Lead implementation of existing AHCCCS VBP initiatives, including Directed Payments, Alternative Payment Models (APM), and Performance Based Payments (PBP). Inform the continued development of new and innovative models. Prepare relevant financial summaries, quality measure withhold and incentive calculations, AHCCCS policies, contract and capitation certification language, and public notices.
• Engage and consult with stakeholders, including providers, managed care organizations (MCOs), and agency leaders and clinical staff, to inform VBP strategies. Conduct research on emerging VBP trends, such as regulatory actions or new programs implemented in other states, and present findings and recommendations. Present complex financial information to diverse audiences.
• Collaborate with clinical teams to incorporate quality performance measures into financial models and align VBP programs with the AHCCCS Quality Strategy.
• Prepare required deliverables for submittal to the Centers for Medicare and Medicaid Services (CMS), including Section 438.6(c) preprints for Access to Professional Services Initiative (APSI), Pediatric Services Initiative (PSI), Differential Adjusted Payments (DAP),Targeted Investments (TI), Nursing Facility Directed Payments, and similar programs. Gather nationally calculated performance measures and summarize for CMS preprint reporting.
• Provide supervision, mentoring, and coaching of the VBP and Rates Analyst and Actuarial Intern to ensure compliance with regulations and policies of the Agency. Facilitate regular 1:1s, team huddles, and other communication modalities with supervised staff. Complete performance appraisals, authorize leave, and approve ETE Timecards.
• Analyze and monitor MCO financial reporting on VBP initiatives, including review of contracts and detailed financial data, to ensure targets are achieved and reporting requirements are met.
• Knowledge of problem-solving variable situations requiring analytical, interpretive, evaluative, and/or constructive thinking within broadly defined policies and objectives Knowledge of commercial and government health insurance analysis, including Value Based Purchasing models.
• Federal Regulations relating to Medicaid and Medicare.
• Agency Policies and Procedures.
• Excellent written and verbal communication skills.
• Present complex materials to diverse audiences.
• Research complex topics and present summary findings and recommendations. Manage multiple projects and competing deadlines.
• Collaborate effectively with cross-functional teams.
• Bachelor’s degree in finance, economics, statistics, health care management, or related field.
• Experience with Arizona Marketplace or other Medicaid Managed Care environment.
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.
ARIZONA MANAGEMENT SYSTEM (AMS)
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results.
State employees are highly engaged, collaborative and embrace a culture of public service.
The State of Arizona is an Equal Employment Opportunity Employer.