Provider Performance Specialist II

About the role

Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes.

Responsibilities

• Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results.
• Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting.
• Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions.
• Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data.
• Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of combined managed healthcare and provider reimbursement experience.
• Claims processing and/or managed care experience preferred.
• For Fidelis Care NY Only: Valid state clinical license preferred (e.g., LPN, RN, etc.).
• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future; sponsorship and future sponsorship are not available for this opportunity.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

Pay

Pay Range: $56,200.00 - $101,000.00 per year

Schedule

Field based position in the New York City area; flexible work arrangements including remote, hybrid, field, or office schedules.