Director, 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

Job Summary: The Director, Provider Performance Engagement is responsible for shaping and implementing strategies that enhance the quality of care of our members, while leading transformational change in the market. This role involves working effectively with all levels of the organization, individuals, and teams across all disciplines to ensure compliance and improve provider performance.

Essential Functions:

• Lead the implementation of Alternative Payment Model (APM) agreements, ensuring that provider performance and engagement are functional and compliant with CareSource provider agreements, ODM, and CMS requirements.
• Lead the development and execution of CareSource's Behavioral Health strategy, focusing on improving access and quality of care for members.
• Coordinate efforts to assess provider APM level and readiness, analyze gaps in care, and work with regional teams to advance providers along the care coordination continuum.
• Contribute to the development of APM quality and performance programs to ensure alignment with Quality, Contracting, and Network Performance, providing standardization among provider entities.
• Oversee day-to-day operations for behavioral health provider performance and relations, ensuring compliance with all state and business operational, clinical, and program requirements.
• Participate in and lead All-Plan activities tied to quality withhold and other regulatory body programs and initiatives.
• Partner with the Provider Network Performance team to ensure quality, performance metrics, and financial performance meet contract specifications for all providers.
• Lead the development and maintenance of departmental policies and procedures.
• Design and implement strategies to increase provider engagement, driving better quality, member satisfaction, improved population health, and reduced healthcare costs.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's in nursing, business, health administration, health policy or related discipline required
• Master's of business administration (MBA), Health Administration (MHA), Health Policy or related field preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Five (5) years of experience clinical experience in healthcare delivery and oversight is required. required
• Five (5) years of leadership/management experience required
• Five (5) years of experience in case management and/or population health preferred
• Experience in managing provider compliance and contracting preferred
• Experience speaking before individuals and groups, vendors, and executive leadership preferred

Competencies, Knowledge and Skills:

• Comprehensive knowledge of APMs, behavioral health, case management, medical management, and quality improvement.
• Strong organizational, analytical, and problem-solving skills.
• Exceptional oral and written communication skills, with the ability to engage effectively with diverse audiences.
• Proven leadership capabilities with a focus on collaboration and relationship building.
• Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel
• Proficient with other technologies such as smartphone or other mobile communication devices
• Knowledge of and application of regulatory standards and measures including but not limited to State Medicaid Programs, Medicare, and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.), quality improvement and HEDIS programs/outcomes measurement
• Knowledge of provider contracting and familiarity with provider operations
• Excellent leadership skills, with ability to effectively manage a high performing team, and provide coaching and development
• Excellent oral, written, and interpersonal communications skills to effectively interact, exercise discretion, judgement and diplomacy when dealing with internal and external customers
• Ability to interact with all levels of leadership, and lead cross-functional teams and initiatives
• Ability to recognize opportunities for improvement, handle complex responsibilities, and lead change
• Highly motivated individual with the ability to adjust to shift priorities, multi-task, work under pressure and meet deadlines

Licensure and Certification:

• Current, unrestricted license as a Registered Nurse (RN), LPN, Social Worker, or other clinical discipline in state of practice required
• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
• 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
• Ability to travel as required by the needs of the department.

Compensation Range: $113,000.00 - $197,700.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.