Remote Provider Performance & Quality Advisor

Search Results; Newtown Square (MD); Hybrid; USD 90,000 - 110,000; Full time

Benefits offered by this job

Flexible work options

Hybrid work schedules

Competitive pay

Paid time off

Health insurance on Day 1

401(k)

Tuition reimbursement

Job summary

AmeriHealth Caritas is seeking a Performance Practice Advisor to support the Provider Network Management team in producing performance reports, VB models, care coordination effectiveness and practice efficiencies.

The Hybrid role based in Louisiana focuses on collaborating with providers on quality measures, interpreting claims data, and driving improvements in HEDIS performance within a state-regulated framework.

Qualifications

• Associate's Degree required.
• Bachelor's degree in healthcare administration or similar field required.
• Five (5) or more years of provider networking experience if no bachelor's degree.
• 3+ years Account Executive experience, total cost of care, understanding of reimbursement methodologies including risk or value-based contracting.
• Understand quality and provider performance reporting and HEDIS or other quality measures.

Responsibilities

• Collaborates with providers on HEDIS, withhold measures, TCOC performance metrics and other quality-based programs.
• Coordinates with the 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 and accountable for improving provider's performance.
• Produces and tracks reports on action plans and outcomes of initiatives that advance provider VB performance.

Skills

Analytical skills

HEDIS knowledge

Quality improvement

Provider performance reporting

Data interpretation

Education

Associate's degree

Bachelor's degree in healthcare administration

Job description

AmeriHealth Caritas is seeking a Performance Practice Advisor to support the Provider Network Management team in producing performance reports, VB models, care coordination effectiveness and practice efficiencies.

The Hybrid role based in Louisiana focuses on collaborating with providers on quality measures, interpreting claims data, and driving improvements in HEDIS performance within a state-regulated framework.