Director, Provider Performance & Engagement

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

Job summary

CareSource in the United States seeks a Director, Provider Performance Engagement to shape and implement strategies that improve member care quality while leading transformational change across the market.

You will work with all levels of the organization to ensure compliance, enhance provider engagement, and drive improvements in care coordination, performance metrics, and population health outcomes that reduce costs.

Qualifications

• Bachelor's degree in nursing, business, health administration, health policy or related discipline.
• Five (5) years of experience clinical experience in healthcare delivery and oversight.
• Five (5) years of leadership experience.
• Experience in provider compliance and contracting preferred.
• Ability to speak before groups and executives.

Responsibilities

• Lead implementation of APM agreements ensuring compliance with provider agreements and CMS requirements.
• Develop and execute Behavioral Health strategy to improve access and quality.
• Coordinate provider APM readiness and analyze care gaps with regional teams.
• Contribute to APM quality programs and ensure alignment with stakeholders.
• Oversee day-to-day operations for behavioral health provider performance and relations.
• Lead cross-functional All-Plan quality activities and regulatory initiatives.
• Partner with Provider Network Performance to meet contract specs and metrics.
• Develop and maintain departmental policies and procedures.
• Design strategies to increase provider engagement, improve outcomes and reduce costs.
• Perform other duties as requested.

Skills

Provider performance

APM knowledge

Behavioral health

Leadership

Change management

Communication

Regulatory compliance

Education

RN license

MBA/MHA preferred

Clinical leadership exp

5+ years clinical exp

5+ years leadership

Tools

CMS/ODM knowledge

Microsoft Office

Contract management

Job description

CareSource in the United States seeks a Director, Provider Performance Engagement to shape and implement strategies that improve member care quality while leading transformational change across the market.

You will work with all levels of the organization to ensure compliance, enhance provider engagement, and drive improvements in care coordination, performance metrics, and population health outcomes that reduce costs.