Manager, Provider Performance Engagement

CareSource; Ohio; Hybrid; USD 83,000 - 133,000; Full time

Job summary

CareSource in Ohio is seeking a Manager, Provider Performance Engagement to oversee performance engagement activities with internal and external partners, aligning provider interventions with customized APM engagement plans and guiding implementation and improvement opportunities.

The role focuses on improving health outcomes and total cost of care, reviewing results, and guiding ROI and quality metrics while reporting progress to stakeholders.

Qualifications

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

Responsibilities

• Conduct meetings to establish and execute provider performance engagement plans.
• Manage customized provider plans to support quality metrics and outcomes.
• Oversee onboarding and oversight processes for providers.
• Ensure compliance with state, federal, and regulatory requirements.
• Develop and maintain departmental policies for oversight of contracted providers in an APM.
• Analyze and update procedures to improve engagement processes.
• Report program metrics, outcomes, and savings opportunities to stakeholders.

Skills

Project management

Stakeholder management

Communication

Leadership

Analytical thinking

Education

Bachelor's degree

Master's degree preferred

Tools

Microsoft Office

Project

Word

Excel

Job description

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

Compensation Range

Compensation Range: $83,000.00 - $132,800.00

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

Equal Opportunity Statement

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. #LI-TS1

Brand

The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.