Provider Performance Strategy Advisor

Search Results; United States; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Flexible work solutions including mock

Health insurance coverage from Day 1

Paid time off including holidays

Job summary

AmeriHealth Caritas in Louisiana seeks a Performance Practice Advisor to support the Provider Network Management team in delivering performance reports, VBC models, and care coordination improvements.

You will collaborate with providers on HEDIS and TCOC metrics, interpret claims data, and drive action plans to close gaps in care, aligning with PNM and CMO objectives; hybrid work arrangement with some statewide travel possible.

Qualifications

• Associate degree required; bachelor degree in healthcare administration or related field preferred.
• 5+ years in provider networking; 3+ years Account Executive with cost of care knowledge.
• Understanding of quality reporting and HEDIS metrics.
• Strong analytical skills and healthcare regulations knowledge.

Responsibilities

• Collaborates with providers on HEDIS withhold measures, TCOC performance metrics and other performance-based programs.
• Coordinates with Quality Team on key reports and initiatives related to provider performance.
• Supports Account Executives and local market provider network team in directing interactions that relate to providers’ quality and performance.
• Responsible for improving provider’s performance.
• Produces all quality and performance reporting for opportunities and action plans.
• Interprets claims data and connections to patient outcomes and utilization trends.

Skills

Healthcare regulations

Quality reporting

Analytical skills

Provider performance

Education

Associate degree

Bachelor’s in healthcare administration or related field

Job description

AmeriHealth Caritas in Louisiana seeks a Performance Practice Advisor to support the Provider Network Management team in delivering performance reports, VBC models, and care coordination improvements.

You will collaborate with providers on HEDIS and TCOC metrics, interpret claims data, and drive action plans to close gaps in care, aligning with PNM and CMO objectives; hybrid work arrangement with some statewide travel possible.