Manager Provider Performance Improvement (Hybrid/Troy, MI) - Health Alliance Plan

General Summary

The Manager of Provider Performance Improvement will oversee provider performance and APM programming, develop and implement initiatives to improve HEDIS rates, cost efficiency, and APM business goals, and present status reports to leadership.

Principle Duties And Responsibilities

• Lead efforts to increase and maximize Quality and cost efficiency outcomes by developing short and long-term strategy across applicable departments.

• Oversee a team of Quality Provider Performance Liaisons tasked with working directly with provider groups on performance improvement.

• Support team in compiling reporting, dashboards, improvement plans, and presentation materials for internal and external audiences.

• Design, implement, and manage comprehensive provider incentives programs in compliance with CMS regulations.

• Oversee and report on interventions for specific quality measures and maintain strategy for measurable impact.

• Provide expertise, direction, and coordination of the health plan’s APM programs.

• Present to internal and external leadership and executive boards with overall status reports on scope of oversight including any issues that may impact the organization.

• Participate in quality and population health workgroups as needed with internal and external entities to drive health plan goals/targets as it relates to APM and provider engagement work.

• Lead complex initiatives to a successful conclusion and ensure that project resources are utilized in an effective and efficient manner.

• Develop, maintain, and improve workflow processes which achieve departmental and HAP targets and timeframes, which positively impact customer satisfaction.

• Coordinate and support improvement activities and optimize efficiencies between the HEDIS and Risk Adjustment teams at HAP.

• Perform other duties as assigned.

Education/Experience Required

• Bachelor’s degree in healthcare, Business Administration or related field.

• Master’s degree in healthcare, Business Administration, Healthcare Administration, Healthcare Policy, Public Health or a related field is preferred.

• Minimum of six (6) years of experience in the health care field, including at least four (4) years of experience in quality measurement, performance outcome improvement, and publicly reported programs.

• Minimum of three (3) years of experience in leading staff in projects or supervisory/management position.

• Minimum of three (3) years of experience with Medicare 5-Star strongly preferred.

• At least four (4) years’ experience in a managed care setting preferred.

• Experience in writing reports for senior leadership and professional audiences.

• Excellent quantitative and qualitative analytical skills.

• Demonstrated verbal and written communication skills at a professional level.

• Ability to work autonomously, cooperatively, and with flexibility in a complex environment.

• Organizational skills to manage multiple projects and frequent changes.

• Ability to persuade, provide direction to, and garner support from others using excellent interpersonal skills.

• Ability to work with minimal supervision, be decisive and achieve goals in expected time frames.

• Knowledge of the health care industry, health maintenance organizations, and health care delivery systems.

• Knowledge of business intelligence applications, data, and tools.

• Knowledge of quality management and measurement principles and techniques in managed care.

• Knowledge of regulatory standards and programs (CMS, NCQA, FEHB, and HEDIS).

• Knowledge of performance improvement methodologies.