Provider Performance & Engagement Lead

CareSource; Massachusetts; Hybrid; USD 72,000 - 116,000; Full time

Job summary

CareSource seeks a Provider Engagement Specialist to lead the performance of delegated partnerships and act as engagement lead for high-value health partners. You will manage performance measures, reports, and improvement plans, ensuring compliance with regulatory and NCQA requirements.

You will collaborate with providers and internal teams to drive quality outcomes, support population health initiatives, and contribute to strategic plans.

Qualifications

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required.
• Master’s Degree is preferred.
• Minimum of five (5) years of healthcare experience, to include three (3) years of direct work experience in provider relations and/or provider contracting.
• Managed care experience is required.
• NCQA PCMH experience is preferred.

Responsibilities

• Oversee performance measure components, including end-to-end data collection, evaluation, and timely reporting to internal teams and delegated providers.
• Lead identified Market performance and engagement strategic initiatives under supervision.
• Serve as market lead for performance and engagement activities to support network performance, new products, and product expansion.
• Develop understanding of program measures to help delegated providers interpret performance data and meet expectations.
• Collaborate with providers to create and monitor performance improvement plans and ensure accountability for baseline standards.
• Drive quality outcomes through execution and support of Value Based Reimbursement with providers.
• Lead Joint Operating Committees with key health partners and present provider performance data.
• Enhance providers’ population health via outcome and quality improvement techniques.
• Coordinate with Population Health Analytics to exchange clinical information and population data.
• Support strategic plans with leadership and analytics teams.
• Collaborate to develop engagement strategies for individual members.
• Generate monthly and quarterly performance and administrative reports for delegated providers.

Skills

MS Outlook

MS Word

MS Excel

Medicaid/Medicare

Value-based care

Provider relations

Provider contracting

Project management

Communication skills

Time management

Education

Bachelor’s degree in healthcare

Master’s degree preferred

Job description

CareSource seeks a Provider Engagement Specialist to lead the performance of delegated partnerships and act as engagement lead for high-value health partners. You will manage performance measures, reports, and improvement plans, ensuring compliance with regulatory and NCQA requirements.

You will collaborate with providers and internal teams to drive quality outcomes, support population health initiatives, and contribute to strategic plans.