Provider Performance Specialist

Spectrum Health; Southfield (MI); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

On-demand pay

Discounts directory

Identity theft protection

Retirement plan

Comprehensive benefits

Job summary

Corewell Health Southfield Center is seeking a strategic professional to advance provider network management across Accountable Care Networks, linking goals to execution and contract renewal, evaluating cost and quality performance, and identifying opportunities for improvement.

You will support the development and execution of strategic plans, analyze performance, manage projects, and drive down total cost of care while aligning economics with business strategy.

Qualifications

• Required Bachelor's Degree or equivalent experience in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience
• 2 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting
• Preferred Master's Degree
• Master's Degree or equivalent Master’s degree in health care administration or business administration or other relevant degree
• 2 years of relevant experience directly interacting in a clinical environment
• Proven experience analyzing and assimilating financial and outcomes data
• Experience delivering presentations to a variety of audiences
• Intermediate level knowledge of Microsoft Office Suite

Responsibilities

• Contribute to the development and execution of provider strategy and solutions for assigned Accountable Care Networks.
• Support the strategy and implementation of strategic business plans; coordinate activities and input to help providers maximize performance.
• Analyze and monitor Accountable Care Networks performance to achieve financial and clinical outcomes.
• Manage projects and implement strategies for complex Accountable Care Networks.
• Contribute to interdisciplinary teams to ensure engagement of all parties.
• Oversee the implementation of payment programs, aligning economics with the business strategy to achieve lower per capita cost.
• Manage and implement programs to drive down the total cost of care through utilization and medical expense trend oversight.
• Manage contract success through analysis of monthly reporting.

Skills

2 years relevant experience

Provider network management experience

Health care insurance experience

Interacting in clinical environment

Presentations to varied audiences

Microsoft Office intermediate

Education

Bachelor's Degree or equivalent

Master's Degree preferred

Tools

Microsoft Office

Job description

Job Summary

Advance the requirements of business and performance improvement plans for assigned Accountable Care Networks (ACN) and large practice groups. Assist in the development and implementation of network engagement strategies linking strategic goals to the execution and renewal of alternative payment model contracts, evaluating cost and quality performance of specific providers and health systems, and identifying opportunities for improvement

Essential Functions

Responsible for contributing to the development and execution of provider strategy and solutions for assigned Accountable Care Networks.

Responsible for contributing to and supporting the strategy, actively involved in the implementation of a strategic business plan; coordinating and managing overall activities and provides input in developing strategies and approaches to help providers maximize performance potential.

Analyze and monitor Accountable Care Networks performance to ensure the achievement of financial and clinical outcomes.

Manage projects and implement strategies pertinent to complex Accountable Care Networks.

Actively contribute to the interdisciplinary Teams to ensure successful engagement of all parties.

Oversee the implementation of payment programs, aligning economics with the business strategy to achieve lower per capita cost.

Manage and implement programs to drive down the total cost of care through utilization and medical expense trend oversight.

Manage contract success through analysis of monthly reporting.

Qualifications

Required Bachelor's Degree or equivalent experience in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience

2 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting

Preferred Master's Degree

Master's Degree or equivalent Master’s degree in health care administration or business administration or other relevant degree

2 years of relevant experience directly interacting in a clinical environment

Proven experience analyzing and assimilating financial and outcomes data

Experience delivering presentations to a variety of audiences

Intermediate level knowledge of Microsoft Office Suite

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Corewell Health Cares for You

Comprehensive benefits package to meet your financial, health, and work/life balance goals.

Learn more here.

On-demand pay program powered by Payactiv.

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance.

Traditional and Roth retirement options with service contribution and match savings.

Eligibility for benefits is determined by employment type and status.

Location & Work Hours

Primary Location SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

Department Name Provider Network Management - PH

Managed Benefits

Employment Type Full time

Shift Day (United States of America)

Weekly Scheduled Hours 40

Hours of Work 8 a.m. to 5 p.m.

Days Worked Monday to Friday

Weekend Frequency N/A

Company Commitment & Culture

We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.

We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other.

From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency.

Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.