Director of Provider Engagement - New York, NY

MetroPlus Health Plan, Inc.; New York (NY); Hybrid; USD 150,000 - 180,000; Full time

Job summary

MetroPlusHealth in New York City is seeking a Director of Provider Engagement to lead the Provider Engagement team and drive performance across quality, risk adjustment, utilization management, and membership growth.

You will coordinate QBRs with major provider partners, oversee Provider Relations for large hospital networks, and collaborate with Quality, Risk, Clinical Services, and Sales to deliver a best-in-class provider experience.

Qualifications

• Master of Public Administration (MPA) or Master of Public Health (MPH) degree required.
• 5-7 years of healthcare industry experience in provider network management or value-based environment.
• Equivalent combination of education, training, and minimum 10 years of relevant experience acceptable.
• Strong healthcare and financial data analysis skills.
• Knowledge of IPAs, large provider groups, hospital systems, and diverse communities.

Responsibilities

• Lead Provider Engagement team to drive quality, risk adjustment, utilization management, financial performance, and membership growth.
• Coordinate Quarterly Business Reviews (QBRs) and operational meetings to drive performance.
• Develop and oversee Provider Engagement functions including establishing key provider partnerships and setting up QBR meetings.
• Establish strategy and action plan with formalized QBR agenda, content, analytics and aligned goals.
• Oversee Provider Relations team assigned to large network hospitals; foster partnerships.
• Review data and analytics of provider group performance to identify improvement opportunities.
• Collaborate with Quality Management, Risk Adjustment, Clinical Services, Sales to monitor trends and plan improvements.
• Ensure compliance with Federal and State rules, regulations, and policies.

Skills

Leadership

Strategic thinking

Data analysis

Communication

Education

MPA or MPH degree

Equivalent combination with 10 years experience

Job description

Empower. Unite. Care.

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Position Overview

Reporting to the Vice President of Provider Network Operations, the Director of Provider Engagement will lead the Provider Engagement team and have overall accountability to develop and maximize alignment, drive high performance and provide world-class engagement experience with identified key strategic provider partners to support quality and growth. Additionally, this role will be responsible for leading a dedicated Provider Relations team supporting the needs of our large hospitals and health system, fostering a strong and collaborative partnership between these providers and MetroPlusHealth. The incumbent will work to address any operational and/or compliance issues as well as provide ongoing education on an as needed basis to help support our providers.

By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth. This team will also serve as the one-stop “Quarterback” for the highest profile groups, including coordinating Quarterly Business Reviews (QBRs) and various operational meetings to drive performance. Success in this role will be measured by aligned goals that include but are not limited to membership growth, quality, risk adjustment, utilization management, and overall financial performance.

Scope of Role & Responsibilities

• Lead team through market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
• Serve as the one-stop “Quarterback” of the team for the highest profile groups, including coordinating Quarterly Business Reviews (QBRs) and various operational meetings to drive performance.
• Develop and oversee all Provider Engagement functions including establishing key provider partnerships aligned with MetroPlusHealth business goals and setting up QBR meetings.
• Establish Provider Engagement strategy and action plan, formalizing QBR agenda, content, analytics and aligned goals.
• Over see Provider Relations team assigned to large network hospitals; foster strong partnerships
• Review data and analytics of key provider group performance to determine areas of focus and develop improvement opportunities.
• Collaborate effectively with internal teams and leaders of Quality Management, Risk Adjustment, Clinical Services, Sales and others to monitor trends and develop strategic plans to improve performance.
• Demonstrate understanding of providers’ business goals and strategies to facilitate the analysis and align on partnership goals.
• Think broadly about health plan provider operations and help develop solutions to meet our provider’s needs and create a best-in-class experience that sets MetroPlusHealth apart from other plans.
• Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; work with other departments to develop quality assurance initiatives based on survey results.
• Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers
• Work cross organizationally to ensure successful implementation of provider performance programs and agreements
• Coach team members in the use of data and appropriate analytical tools that support improved quality and support team members in the identification and creative problem resolution for improved processes and expanded use of technology
• Ensures department staff remains current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes.
• Develop and maintain Executive level monthly reporting on all Provider Engagement activity, performance, and progress to goals.
• Develop monthly executive report of key provider performance and activity, including but not limited to progress on goals and initiatives.
• Fosters a culture of accountability that emphasizes people and performance management, coaching and development and employee engagement.
• Responsible for department staffing decisions and providers supervision to assigned staff, writes and performs annual reviews and monitors performance issues as they arise.
• Responsible for the hiring and training process including recommendations regarding staff retention, termination and succession planning
• Performs other support activities and duties as assigned

Required Education, Training & Professional Experience

• Master of Public Administration (MPA) or Master of Public Health (MPH) degree required; and
• 5-7 years of relevant healthcare industry experience in a provider network management and value-based environment; or
• A satisfactory equivalent combination of education, training, and minimum 10 years of relevant healthcare industry experience in a provider network management and value-based environment.
• Solid background in healthcare, preferably experience working in a network management and value-based role required.
• Must have excellent healthcare and financial data analysis skills.
• Knowledge of IPAs, large provider groups, hospital systems, and diverse communities required to target providers that serve different demographics.
• Ability to decipher contractual language and clearly deliver messages to clients and customers with written and verbal communication.
• Experience facilitating and/or contracting arrangements.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization, including executive and C-level.
• Demonstrated self-starter, strategic thinker, ability to manage complexity and ambiguity
• Adapt quickly to change in an ever-changing environment.
• Ability to develop solid long-term positive working relationships.
• Ability to drive effective change
• Strong business acumen, analytical, critical thinking, and persuasion skills
• Proven track of building and cross-functional relationships
• Demonstrated ability to lead and develop strong, effective teams.

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