Director, Provider Performance Engagement

About the role

The Director, Provider Performance Engagement is responsible for shaping and implementing strategies that enhance the quality of care of our members, while leading transformational change in the market. This role involves working effectively with all levels of the organization, individuals, and teams across all disciplines to ensure compliance and improve provider performance.

Responsibilities

• Lead the implementation of Alternative Payment Model (APM) agreements, ensuring that provider performance and engagement are functional and compliant with CareSource provider agreements, ODM, and CMS requirements.
• Lead the development and execution of CareSource's Behavioral Health strategy, focusing on improving access and quality of care for members.
• Coordinate efforts to assess provider APM level and readiness, analyze gaps in care, and work with regional teams to advance providers along the care coordination continuum.
• Contribute to the development of APM quality and performance programs to ensure alignment with Quality, Contracting, and Network Performance, providing standardization among provider entities.
• Oversee day-to-day operations for behavioral health provider performance and relations, ensuring compliance with all state and business operational, clinical, and program requirements.
• Participate in and lead All-Plan activities tied to quality withhold and other regulatory body programs and initiatives.
• Partner with the Provider Network Performance team to ensure quality, performance metrics, and financial performance meet contract specifications for all providers.
• Lead the development and maintenance of departmental policies and procedures.
• Design and implement strategies to increase provider engagement, driving better quality, member satisfaction, improved population health, and reduced healthcare costs.
• Perform any other job related duties as requested.

Qualifications

• Bachelor's in nursing, business, health administration, health policy or related discipline required
• Master's of business administration (MBA), Health Administration (MHA), Health Policy or related field preferred
• Equivalent years of relevant work experience