Blueprint Payment Operation Administrator - Limited Service

at State of Vermont in Waterbury, Vermont, United States

Job Description

The Blueprint for Health was established to promote high-quality care that integrates advanced primary care, specialty care and community-based services to impact Vermonters' health and wellbeing. Advanced primary care encompasses prevention services as well as integration of care and services for people with complex health and social needs. Supported by multi-payer participation, the Blueprint has built a foundation of advanced primary care based on the Patient-Centered Medical Home (PCMH) model and bolstered by multi-disciplinary Community Health Teams (CHTs) that provide care coordination and linkages to services across the care continuum and in the community. Essential to the success of the PCMHs and CHTs is the clear articulation of standards, intervention, outcome measures and data analytics. 

This position is responsible for directing and supporting the administration of quality initiatives for the Blueprint Program, including work associated with the Rural Health Transformation (RHT) Project and helping to create a coordinated infrastructure to accelerate the modernization of the Vermont Blueprint for Health's Advanced Primary Care Model. The role ensures expert construction of quality measures, supports data-driven program evaluation, and serves as a key liaison between internal teams and external stakeholders. The position requires strong analytical skills, attention to detail, and the ability to communicate a wide variety of best practices related to advanced primary care standards, prevention guidelines, sub-specialty best practices and case management standards combined with experience translating complex data into actionable insights.

Key Responsibilities
•  Support the administration of payments and quality initiatives for the Blueprint Program, ensuring accuracy, consistency, and compliance with program rules and policies. 
•  Communicate with field staff and community partners to gather, validate, and interpret program-related information. 
•  Extract, integrate, and transform data from multiple sources using appropriate data systems and tools; apply program rules and policy guidance to calculate provider payments and quality performance measures. 
•  Document methodologies, workflows, and processes related to quality reporting, datasets, and analytical tools to ensure transparency, reproducibility, and compliance. 
•  Develop and complete recurring data and narrative reports on quality metrics and program performance, supporting evaluation and continuous improvement efforts. 
•  Analyze program data, quality measures, and provider metrics in collaboration with the Blueprint Data Team to inform reporting and program improvement. 
•  Communicate payment and quality information to internal and external stakeholders, respond to inquiries, and maintain clear, consistent communication materials for program operations and data use across insurers, providers, field teams, and agency staff.

The Rural Health Transformation (RHT) project is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $195,053,740.44 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

Duties are performed primarily in a standard office setting.  Occasional travel may be required for which private means of transportation must be available.  Some work outside of normal office hours may be required.