Provider Improvement Analyst

About the Role

The Provider Engagement Specialist - Provider Delegation Performance oversees and improves the performance of delegated partnerships programs, acting as the engagement lead for high-value, strategic health partners.

Responsibilities

• Assume full management responsibility for all performance measure components, including end-to-end data collection, evaluation, and timely dissemination of reports to internal teams and delegated providers.
• Lead identified market performance and engagement strategic initiatives under direct supervision.
• Serve as the market lead for performance and engagement activities to support overall network performance, new products, and product expansion.
• Develop a deep understanding of all program measures and metrics to support delegated providers in interpreting performance data and meeting expectations.
• Collaborate with providers individually to create and monitor performance improvement plans, engaging internal subject matter experts as needed and ensuring accountability for baseline performance standards.
• Maintain knowledge of federal and state laws and regulations pertaining to provider contracting.
• Drive quality outcomes through execution and support of Value-Based Reimbursement agreements with providers.
• Assume a leadership role in Joint Operating Committees (JOCs) with key health partners, developing and presenting data on provider performance.
• Enhance the effectiveness of providers’ population health through member health outcome and quality improvement techniques.
• Collaborate with the Population Health Analytics team to coordinate the exchange of clinical information and member/population-level data.
• Assist in the development and implementation of strategic plans in collaboration with leadership and the population health analytics team.
• Collaborate with providers to develop and enhance practice engagement strategies for individual members.
• Generate monthly and quarterly performance and administrative reports, ensuring consistency, accuracy, and timely distribution to delegated providers, including reporting related to contracts, regulatory, NCQA, and other requirements.
• Provide on-site practice transformation support and education to providers identified as partners in the CareSource PCMH program, supporting the NCQA Patient-Centered Medical Home model.
• Work with leadership and stakeholders to evaluate policy and process changes for potential provider impacts, monitor implementation of key initiatives, and provide leadership on initiatives affecting providers.
• Ensure CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards, and participates in market audits.
• Perform any other job duties as requested.

Requirements

• Bachelor’s degree in a healthcare-related field or equivalent years of relevant work experience is required.
• Master’s degree is preferred.
• Minimum of five (5) years of healthcare experience, including three (3) years of direct work experience in provider relations and/or provider contracting.
• Managed care experience is required.
• NCQA PCMH experience is preferred.

Skills

• Intermediate proficiency with Microsoft Outlook, Word, and Excel.
• Experience with Medicaid and Medicare products and programs.
• Value-based program oversight and performance tracking.
• Experience working within FQHCs, Health and Human Services providers, or equivalent.
• Knowledge of Provider Network Management Processes & Services.
• Proven experience in program management and performance monitoring initiatives or relevant positions.
• Working knowledge of project/program management practices.
• Ability to manage and prioritize multiple tasks, promote teamwork, and make fact-based decisions.
• Strong negotiation skills.
• Effective oral and written communication skills.
• Critical listening and thinking skills.
• Training/teaching skills.
• Time management skills.
• Six Sigma Certification or Project Management certification preferred.

Licensure and Certification

• Employment is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or employment terminated.
• Annual proof of Influenza vaccination is required for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.

Working Conditions

• Mobile Worker: Regular travel to different work locations is essential. Exposure to weather conditions typical of the location and may require standing and/or sitting for long periods.
• Must reside in the same territory assigned to work in; exceptions may be considered due to business need.
• May be required to travel greater than 50% of the time for work duties. A valid driver’s license, car, and insurance are necessary for work-related travel.
• Required to use general office equipment such as a telephone, photocopier, fax machine, and personal computer.
• Flexible hours, including possible evenings and/or weekends as needed to represent CareSource.

Pay

$72,200.00 - $115,500.00. Salary is determined by a combination of education, training, experience, the position’s scope and complexity, discretion and latitude required, and other external and internal data. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package.