Manager, Provider Performance Engagement-Must Reside in OHIO!

CareSource; Columbus (OH); Sur place; USD 83 000 - 133 000; Plein temps

Résumé du poste

CareSource in Columbus, OH is seeking a Manager, Provider Performance Engagement to oversee engagement activities with internal and external partners, aligning provider interventions with APM plans to improve health outcomes and reduce costs.

You will lead meetings, manage customized provider plans, ensure regulatory compliance, analyze program metrics, and drive ROI while maintaining stakeholder alignment across projects.

Qualifications

• Bachelor's degree or equivalent years of relevant work experience is required.
• Master’s degree in business or health related field is preferred.
• Familiarity of the healthcare field and experience with payer-provider integration is required.
• 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
• Flexibility during organizational and/or business changes
• Demonstrates strong analysis and collaboration skills
• Exceptional emotional intelligence
• Strong interpersonal and relationship building skills
• Ability to multi-task and prioritize work to meet project deadlines
• Customer service oriented
• Excellent planning, negotiating and influencing skillset

Responsabilités

• 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.
• 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)
• 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
• 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

Connaissances

Project management

MS Office Suite

Data analysis

Regulatory knowledge

PCMH concepts

Stakeholder communication

Interpersonal skills

Emotional intelligence

Multitasking

Negotiation skills

Formation

Bachelor's degree or equivalent

Master’s degree in business or health-related field

Outils

Microsoft Project

Microsoft Word

Microsoft Excel

Description du poste

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.

• 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.
• 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)
• 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
• 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

Requirements

• Bachelor's degree or equivalent years of relevant work experience is required
• Master’s degree in business or health related field is preferred
• Familiarity of the healthcare field and experience with payer-provider integration is required
• 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
• Flexibility during organizational and/or business changes
• Demonstrates strong analysis and collaboration skills
• Exceptional emotional intelligence
• Strong interpersonal and relationship building skills
• Ability to multi-task and prioritize work to meet project deadlines
• Customer service oriented
• Excellent planning, negotiating and influencing skillset

Additional Information

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.

Benefits & Compensation

General office environment; 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. Compensation Type (hourly/salary):

CareSource Values

Cultivate Partnerships

Pursue Personal Excellence

Understand the Business