Manager, Provider Performance Engagement

Job Summary:

The Manager, Provider Performance Engagement is accountable for overseeing the performance engagement activities with internal and external partners.  With a focus on improving health outcomes and total cost of care, the manager, Provider Performance Engagement closely aligns Provider interventions with customized APM engagement plans, oversees implementation, assesses results, and lends guidance for improvement opportunities.

Essential Functions:

Conduct internal and external meetings to establish and execute on detailed provider performance engagement plans for new and existing providers

Manage customized provider plans to support key quality metrics to ensure positive outcomes.

• Manage process development activities for provider onboarding and oversight
• Ensure compliance with state, federal and regulatory body requirements
• Assist with the development and maintenance of departmental policies and procedures for oversight of contracted providers in an Alternative Payment Model (APM)
• Analyze, update, and modify procedures to continually improve engagement processes
• Review and incorporate data analysis for program metrics, outcome measures and results, and savings opportunities
• Support and manage financial ROI, quality metrics, and service level agreements to evaluate success of provider engagement initiatives
• Identify and manage risk associated with any process change, implement mitigation strategies & communicate/escalate to stakeholders
• Report provider APM program progress and oversight status to all stakeholders
• Ensure provider performance engagement milestone deliverables are completed for each project phase

Maintain internal strategic alignment when prioritizing projects by following established RACI document to ensure appropriate engagement for stakeholders, Participate in Provider Oversight Committee meetings with internal business owners and providers

• Provide leadership guidance to ensure staff career growth
• Oversee day-to-day activities of staff to ensure department goals are achieved
• Strategically manage department staff objectives and prioritization to ensure alignment with market and corporate goals
• Perform any other job-related instructions as requested

Education and Experience:

• Bachelor's degree or equivalent years of relevant work experience is required
• Master’s degree in business or health related field is preferred
• Minimum of five (5) years of experience working collaboratively with external Health Partners is required
• Familiarity of the healthcare field and experience with payer-provider integration is required
• Minimum of one (1) year leadership/management experience preferred

Competencies, Knowledge and Skills:

Proficient in Microsoft Office tools, including Project, Word, and Excel

Thorough understanding of project management processes, techniques and tools

In-depth knowledge of regulatory and quality standards and measures including but not limited to State Medicaid programs, Medicare and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.)

• In-depth knowledge of Patient Centered Medical Home (PCMH) concepts and processes
• Ability to communicate before individuals, groups, and executive leadership
• Proven ability to effectively interact with all levels of management within the organization
• Flexibility during organizational and/or business changes
• Demonstrates strong analysis and collaboration skills
• Demonstrate sense of urgency
• Exceptional emotional intelligence
• Excellent written and verbal communication skills
• Strong interpersonal and relationship building skills
• Ability to work independently and within a team environment
• Ability to multi-task and prioritize work to meet project deadlines
• Effective listening and critical thinking skills
• Time management skills
• Customer service oriented
• Decision making/problem solving skills
• Excellent planning, negotiating and influencing skillset

Licensure and Certification:

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time