Provider Practice Performance Advisor

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 50 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

About the Role

AmeriHealth Caritas is seeking talented, passionate individuals to join our team as a Performance Practice Advisor. This role is part of the POD support model and provides support to the Provider Network Management team and Provider Network, focusing on producing and presenting performance reports, value-based care (VBC) models, care coordination effectiveness, and practice efficiencies.

As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience delivering comprehensive, outcomes-driven care.

Responsibilities

• Collaborates with providers on HEDIS, withhold measures, TCOC performance metrics, and other performance-based programs.
• Coordinates with the Quality Team on key reports and initiatives related to provider performance.
• Supports Account Executives and local market provider network teams in directing interactions related to providers’ quality and performance.
• Responsible for improving provider performance through regular reporting and strategy development for Joint Operating Committees (JOCs).
• Interprets claims data and connects it to patient outcomes and utilization trends.
• Analyzes utilization trends and optimizes performance based on state-driven quality improvement programs (e.g., HEDIS).
• Attends meetings with providers to review gaps in care and develop action plans to address these gaps in conjunction with Provider Network Management (PNM) and Chief Medical Officer (CMO).
• Supports network and quality strategy, implementing performance-related projects aligned with corporate best practices.
• Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies for provider action plans.
• Conducts meetings with providers to review performance data and discuss areas of opportunity to strengthen partnerships.
• Tracks and prepares reports on action plans and outcomes of initiatives that advance provider value-based performance annually.
• Provides cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality programs to achieve goals and objectives.
• May assist with scheduling appointments for members and attend member outreach meetings in addition to provider meetings.

Requirements

• Associate's degree required; Bachelor’s degree in healthcare administration or a similar field preferred.
• Five or more years of experience in provider networking if no bachelor's degree is held.
• Three or more years of Account Executive experience, including knowledge of total cost of care, reimbursement methodologies, risk, or value-based contracting.
• Understanding of quality and provider performance reporting, HEDIS, or other quality measures.
• Familiarity with healthcare regulations, reimbursement models, and quality measures.
• Strong analytical skills to interpret and prepare provider performance data.
• Knowledge of value-based contracts with providers as they relate to HEDIS, withhold measures, TCOC performance metrics, and other quality-based programs.
• General operational knowledge related to provider satisfaction, education, and communication, including claims coding, payment integrity, provider data, credentialing, appeals, and disputes, applicable to State, Federal, and STARS standards.

Schedule

This is a hybrid role. The associate must be located in Louisiana (LA).

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off, including holidays and volunteer events.
• Health insurance coverage for you and your dependents starting on Day 1.
• 401(k) retirement plan.
• Tuition reimbursement.