Director of Provider Performance & Engagement

CareSource; Kentucky; Hybrid; USD 113,000 - 198,000; Full time

Job summary

CareSource is seeking a Director, Provider Performance Engagement to shape and implement strategies that improve member care quality and drive transformational change across the market. The role requires collaboration with diverse teams to ensure compliance and enhance provider performance.

Responsibilities include leading APM initiatives, developing a Behavioral Health program, and coordinating provider readiness across regional teams while meeting regulatory requirements and contract

Qualifications

• Bachelor's degree in nursing, business, health administration, health policy or related discipline required
• MBA, MHA or related field preferred
• Five years of clinical healthcare delivery and oversight experience required
• Five years of leadership/management experience required
• Experience in case management/population health preferred
• Experience with provider compliance and contracting preferred
• Experience presenting to executives and stakeholders preferred

Responsibilities

• Lead implementation of Alternative Payment Model (APM) agreements and ensure provider performance aligns with CareSource, ODM, and CMS requirements
• Shape and execute CareSource's Behavioral Health strategy to improve access and care quality
• Assess provider APM level, identify gaps, and collaborate with regional teams to advance care coordination
• Develop and maintain department policies and procedures
• Lead cross-functional teams to improve provider engagement, quality, and population health outcomes
• Ensure day-to-day operations of behavioral health provider performance and relations meet regulatory and contractual standards
• Collaborate with Provider Network Performance to meet contract specifications for quality, performance and financial metrics
• Lead All-Plan quality withhold activities and related regulatory programs
• Travel as required and manage shift priorities to meet deadlines

Skills

Leadership

Communication

APM knowledge

Behavioral health

Contracting

Quality improvement

Regulatory compliance

Education

Bachelor's degree

MBA/MHA preferred

Tools

Microsoft Office

CMS systems

Job description

CareSource is seeking a Director, Provider Performance Engagement to shape and implement strategies that improve member care quality and drive transformational change across the market. The role requires collaboration with diverse teams to ensure compliance and enhance provider performance.

Responsibilities include leading APM initiatives, developing a Behavioral Health program, and coordinating provider readiness across regional teams while meeting regulatory requirements and contract