Provider Performance Manager

1 day ago

Philadelphia, United States Independence Blue Cross Full time
Looking for a chance to show what you can do in an environment that will appreciate you and help you grow? If you are learning-oriented, strive for excellence, and have a strong customer commitment, bring your talents to Independence Blue Cross as we seek to enhance the health and well-being of the people and communities we serve. As a member of Independence Health Group, we seek to innovate, reimagine and lead in the transformation of healthcare. We are committed to attracting, retaining and growing the best talent.

The functions of this position include:
  • Responsible for the management of value-based program (e.g., Full Risk, Upside/Downside Shared Savings, Pay-for-Performance, etc.) including, but not limited to, end-to-end program processes, program design and implementation, project tasks, report delivery, provider measurement and program performance summaries.
  • Accountable for design and implementation of new value-based payment models for health systems, ACOs, and physicians.
  • Develops presentation materials for provider external meetings and regularly meets with providers to review program results, analytics, comparisons, improvement opportunities and best-practices.
  • Develops short and long term strategies around value-based program design development and direction; evaluates new program design metrics and reimbursement strategies with cross-functional team support (medical directors, legal, actuarial, informatics)
  • Accountable for coordinating all existing, and new, value-based reporting and analytics with informatics team. Manages report requests and creates new reporting business requirements.
  • Responsible for developing and tracking value-based program budgets and works with provider reimbursement and actuarial to ensure necessary updates are made to budget tracking processes.
  • Performs other job-related duties as assigned


Qualifications:
  • Bachelor's degree; At least 8-10 years' progressive experience in healthcare/managed care preferred
  • Thorough understanding of managed care finance, operations and processes is required.
  • Previous experience in Provider Contracting and Reimbursement, finance, informatics and operations is preferred.
  • Excellent project management skills and ability to coordinate multiple streams of work and processes.
  • Excellent organization, presentation, analytical, interpersonal, written and verbal communication skills.
  • Previous successful leadership experience including management of teams.
  • Able adapt quickly and easily to a rapidly changing business environment.


Hybrid

Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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