You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Value-based care is the leading strategy in healthcare transformation aimed at improving positive health outcomes, advancing quality and ensuring equity in healthcare delivery today. The Manager, Value-Based Payments Initiatives (VBP) will lead and support the expansion and optimization of Medicare-focused VBP arrangements across New York. This role is critical in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs). The Manager will serve as a subject matter expert in Medicare VBP frameworks, overseeing a team responsible for transitioning providers from contract execution to operational implementation and performance monitoring. The position will collaborate cross-functionally with corporate Service Fund and National Medicare contracting teams to contract key partners to advance population health, improve quality outcomes, and achieve financial sustainability under CMS-aligned risk-based models. This position will be responsible for working with the VBP Director, other VBP Managers, and Analysts, as well as cross functional teams to meet enterprise goals. The VBP Manager will assist in the execution of the organization’s Value-Based Payment strategies (VBP) and other risk-based contracting strategies.
- Oversee Medicare-specific VBP contracts, focusing on implementation, performance management, and education of provider partners regarding CMS-aligned models, such as upside/downside risk, shared savings, and global capitation.
- Lead a team of analysts responsible for Medicare VBP contract execution, ensuring timely sharing of performance reports and proactive identification of improvement opportunities.
- Develop and refine Medicare contract models to incorporate RAF (Risk Adjustment Factor) trends, Stars quality metrics, and benchmarking methodologies to align with NYSDOH and CMS guidelines.
- Act as a strategic advisor on contract structure and payment methodologies for Medicare Advantage and D-SNP providers, supporting new contract negotiations and renewals.
- Partner with internal teams (e.g., Actuarial, Legal, Clinical, and Provider Relations) to align on quality incentive programs, attribution logic, and provider engagement strategies.
- Represent Medicare VBP in governance discussions and escalate operational issues or contracting roadblocks to VBP leadership with proposed resolutions.
- Monitor evolving CMS policies, regulatory changes, and Stars measures to ensure VBP strategies remain compliant and competitive.
- Identify opportunities to scale Medicare VBP performance, including exploring new models, refining financial benchmarks, and promoting provider accountability.
- Travel occasionally to existing and potential VBP partners
Education/Experience: Bachelors Degree Required. MBA/MHA/MPH Preferred. 2-5 years of relevant managed care experience including at least 1 year of experience implementing/managing VBP programs or at least 18 months of experience working on the implementation of VBP arrangements with at least an additional 2 years of relevant experience required. Graduate education in health care administration or other related areas may be used to partially offset the Education/Experience described above. 5–7 years of experience in managed care or healthcare consulting with a focus on Medicare Advantage with at least 2-3 years in a value-based care role overseeing Medicare VBP program implementation or performance preferred. 1-3 years of managerial or team leadership experience preferred. Strong experience in contract modeling, financial reconciliation, and interpreting CMS policy preferred. Proficient in Microsoft Excel and PowerPoint; experience with data visualization tools (e.g., Power BI) a plus. Ability to control and complete projects on time; involve others in planning; estimate effort in time and duration to complete assigned analysis tasks. Ability to communicate with technical and business constituencies effectively. Experience in writing business specifications and requirements.
Please note: this is a hybrid position and will require the candidate to commute to our Long Island City, NY office 2-3 days a week.
Pay Range: $86,000.00 - $154,700.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
