Manager, Provider Performance Program Management

Job Summary:

The Manager, Provider Performance Program Management is accountable for the overall engagement approach and strategy to support the Alternative Payment Model (APM) program across all lines of business.

Essential Functions:

• Accountable for increased quality and financial performance for Providers
• Program manage provider engagement utilizing input from Provider Network performance team, Ohio Quality, Regulatory, contracting, and other internal stakeholders, to ensure efficiencies and coordinated efforts across the Ohio Market
• Establish and maintain strong working relationships with key internal business partners
• Develop, implement and evaluate provider engagement approach, including a plan to meet annual goals and objectives for APM strategy
• Develop detailed dashboards and tools to track provider engagement interventions, progress to thresholds, barriers and resolutions pertinent to APM programs
• Create executive reports, in aggregate, for provider activities and outcomes
• Provide statewide strategic direction and recommendations for APM providers on accountability for engagement functions
• Manage and support programs designed to achieve Quality Withhold targets, including All-Plan work and activities
• Recommend new processes and changes for increased department productivity and efficiencies
• Develop processes and structure to ensure consistency across geographic areas related to provider approach and engagement with a focus on Social Determinants of Health (SDOH) and Health equity.
• Ensure compliance with state, federal and regulatory body requirements
• Create and manage tracking for financial ROI, quality metrics, and service level agreements to evaluate success of growth engagement initiatives
• Perform any other job related instructions as requested

Education and Experience:

• Bachelor's degree or equivalent years of relevant work experience is required
• Minimum of three (3) years of healthcare, managed care, or administrative experience is required.
• Familiarity of the healthcare field and experience with payer-provider partnerships is preferred
• Experience with Alternative Payment Model execution is preferred
• Minimum of one (1) year leadership/management experience preferred

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office tools, including Project, Word, and Excel, along with Teams and SharePoint
• 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 and APMs, Medicare and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.)
• Research, data analysis and trending knowledge
• Proven ability to effectively interact with all levels of management within the organization
• Ability to coordinate complex projects
• Ability to engage teams in a positive, energetic manner
• Familiarity of the healthcare field and managed care requirements
• Flexibility during organizational and/or business changes
• Demonstrates strong analysis and collaboration skills
• Ability to communicate before individuals, groups, and executive leadership
• 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:

• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

Salary : $81,400 - $130,200