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.
Essential Functions:
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.
Manage process development activities for provider onboarding and oversight
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)
Analyze, update, and modify procedures to continually improve engagement processes
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
Report provider APM program progress and oversight status to all 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
Provide leadership guidance to ensure staff career growth
Oversee day-to-day activities of staff to ensure department goals are achieved
Strategically manage department staff objectives and prioritization to ensure alignment with market and corporate goals
Perform any other job-related instructions as requested
Education and Experience:
Bachelor's degree or equivalent years of relevant work experience is required
Master’s degree in business or health related field is preferred
Minimum of five (5) years of experience working collaboratively with external Health Partners is required
Familiarity of the healthcare field and experience with payer-provider integration is required
Minimum of one (1) year leadership/management experience preferred
Competencies, Knowledge and Skills:
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
Ability to communicate before individuals, groups, and executive leadership
Proven ability to effectively interact with all levels of management within the organization
Flexibility during organizational and/or business changes
Demonstrates strong analysis and collaboration skills
Demonstrate sense of urgency
Exceptional emotional intelligence
Excellent written and verbal communication skills
Strong interpersonal and relationship building skills
Ability to work independently and within a team environment
Ability to multi-task and prioritize work to meet project deadlines
Effective listening and critical thinking skills
Time management skills
Customer service oriented
Decision making/problem solving skills
Excellent planning, negotiating and influencing skillset
Licensure and Certification:
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