Manager, Provider Performance Engagement-Must Reside in OHIO!

CareSource; Ohio; On-site; USD 83,000 - 133,000; Full time

Job summary

CareSource is seeking a Manager of Provider Performance Engagement to oversee engagement activities with internal and external partners, aligning provider interventions with APM plans to improve health outcomes and total cost of care.

Responsibilities include planning, implementing, and assessing provider programs, ensuring regulatory compliance, and driving ROI and quality metrics across projects. Strong PM, analytics, and stakeholder management are essential.

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 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

Responsibilities

• 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

Skills

Healthcare domain knowledge

PM processes

Analytical skills

Interpersonal skills

Team collaboration

Customer service oriented

Planning & negotiation

Emotional intelligence

Relationship building

Time management

Problem solving

Change adaptability

Microsoft Office

Project

Excel

Word

Education

Bachelor's degree

Master’s degree in business or health

Tools

Microsoft Project

Microsoft Word

Microsoft 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.

• 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

• 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

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.

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):

• Cultivate Partnerships
• Pursue Personal Excellence
• Understand the Business