This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2202228
Provider Performance Director, Medicare Advantage (HEALTHCARE)
Telecommute or Tele-Flex Options (Depending on location) - Must reside
in ID, OR, UT or WA
WHO WE NEED
The Government Programs Provider Performance Director develops provider
engagement strategies to drive performance improvements critical
objectives such as population health management, Medicare Stars, and
Risk Adjustment. They are responsible for creating and deploying
actionable campaigns to enable provider performance, including analyzing
performance data, setting targets, and communicating improvements. They
are also responsible for identifying innovative interventions to support
provider practice transformation and meet the needs of Regence members.
Finally, they 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.
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
models
Normally 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 proble s, 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)
The expected target hiring range for this position is \$135k -
\$145k depending on skills, experience, education, and training;
relevant licensure / certifications; performance history; and work
location. The bonus target for this position is 20%. The current full
salary range for the Provider Performance Director, Medicare Advantage
is \$124k Low Range / \$156k MRP / \$203k High Range,.
Base pay is just part of the compensation package at Cambia that is
suppleme