Provider Performance Director, Medicare Advantage
Company: Cambia Health Solutions, Inc
Location: Renton
Posted on: May 7, 2024
Job Description:
Provider Performance Director, Medicare Advantage
(HEALTHCARE)Telecommute or Tele-Flex Options (Depending on
location) - Must reside in ID, OR, UT or WAWHO WE NEEDAre you a
strategic leader with a passion for driving improvement in
healthcare? Do you have experience in provider engagement and
performance management? We're searching for a talented Government
Programs Provider Performance Director to join our team!As a
Government Programs Provider Performance Director, you'll develop
provider engagement strategies to drive performance improvements in
critical objectives such as population health management, Medicare
Stars, and Risk Adjustment.Here are some of the exciting
responsibilities you'll have:Analyzing Performance Data: You'll
analyze performance data to identify areas for improvement and set
targets for provider performance.Communicating Improvements: You'll
communicate improvements and best practices to providers, enabling
them to deliver high-quality care to Regence members.Innovative
Interventions: You'll identify innovative interventions to support
provider practice transformation and meet the needs of Regence
members.Strategies and Initiatives: You'll develop strategies and
manage initiatives, projects, and workstreams in consultation with
internal experts and regional market strategies to drive
sustainable performance improvement in quality and outcomes.If
you're a strategic thinker with a passion for driving improvement
in healthcare, we want to hear from you! Apply now and join our
team as a Government Programs Provider Performance
Director!Preferred Key Experience:
- Familiarity with Medicare Advantage and its business model
- Experience at a provider organization in population health or
in provider relations/engagement at a plan
- Familiarity w/ value-based care, including shared savings/risk
modelsNormally to be proficient in the competencies listed
below:The Government Programs Provider Performance Director would
have
- Bachelor's Degree (Master's Degree preferred) in healthcare,
science, business or related field
- 12+ years' experience in one of the following areas: population
health management, Provider contracting and reimbursement, managed
care, healthcare delivery, risk adjustment, Stars
- Or equivalent combination of education and experience.YOUR
ROLE:
- Initiates and leads network efforts focused on industry best
practices. Acquires deep knowledge of cost, quality, and
utilization metrics to oversee performance of provider controllable
measures for all contracted groups. Identifies barriers and offers
tailored solutions based on group cultures and competencies.
- Contributes to the overall development and execution of
cohesive and coordinated network business strategies by working
with Network Management leadership, Government Programs teams and
subject matter experts to support action plans. Partners with the
Network Management market team to identify key stakeholders and
technologies within provider groups to support key initiatives and
strategies.
- Improves provider organization performance through data
analysis, knowledge of best practices, and development and
execution of interventions in collaboration with peers and leaders
of contracted healthcare delivery systems.
- Serves as a Subject Matter Expert on MA programs and objectives
such as quality, risk adjustment, and other Medicare programs and
stays informed and updated on measures, program changes and quality
gap closure processes. Establishing credibility as a trusted
advisor and resource to influence positive change while imparting a
great company image and professional demeanor.
- Develops and deploys best-practice network
incentives/recognition. Participates in internal workgroups to
support development of effective member and provider
network-directed interventions; coordinates interventions with
internal stakeholders.WHAT YOU BRING:
- Demonstrated knowledge of medical group/IPA operations,
integrated delivery systems, and health plans, as well as industry
trends, challenges and solutions as they relate to improved
performance in Medicare
- Knowledge of provider coding, documentation practices,
reimbursement and contract methodologies
- Demonstrated acumen identifying problems, developing solutions,
and implementing a chosen course of action to resolve issues and
build consensus among groups of diverse stakeholders. Ability to
develop and drive new initiatives from concept through execution,
including developing, managing and leading complex projects.
- Demonstrated ability to develop relationships quickly and
leverage working relationships to drive performance outcomes.
Excels at working with all levels of staff, within and external to
the organization, to achieve goals.
- Strong written and verbal communication and facilitation
skills, excellent presentation and public speaking skills (formal
and informal)
Keywords: Cambia Health Solutions, Inc, Seattle , Provider Performance Director, Medicare Advantage, Executive , Renton, Washington
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