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Provider Performance Director, Medicare Advantage
4 months ago
WHO WE NEED
The Government Programs Provider Performance Director develops provider engagement strategies to drive performance improvements critical objectives such as population health management, Medicare Stars, and Risk Adjustment. They are responsible for creating and deploying actionable campaigns to enable provider performance, including analyzing performance data, setting targets, and communicating improvements. They are also responsible for identifying innovative interventions to support provider practice transformation and meet the needs of Regence members. Finally, they develop strategies and manage initiatives, projects, and workstreams in consultation with internal experts and regional market strategies to drive sustainable performance improvement in quality and outcomes.
Preferred Key Experience:
- Familiarity with Medicare Advantage and its business model
- Experience at a provider organization in population health or in provider relations/engagement at a plan
- Familiarity w/ value-based care, including shared savings/risk models
Normally to be proficient in the competencies listed below:
The Government Programs Provider Performance Director would have
- Bachelor's Degree (Master's Degree preferred) in healthcare, science, business or related field
- 12+ years' experience in one of the following areas: population health management, Provider contracting and reimbursement, managed care, healthcare delivery, risk adjustment, Stars
- Or equivalent combination of education and experience.
YOUR ROLE:
- Initiates and leads network efforts focused on industry best practices. Acquires deep knowledge of cost, quality, and utilization metrics to oversee performance of provider controllable measures for all contracted groups. Identifies barriers and offers tailored solutions based on group cultures and competencies.
- Contributes to the overall development and execution of cohesive and coordinated network business strategies by working with Network Management leadership, Government Programs teams and subject matter experts to support action plans. Partners with the Network Management market team to identify key stakeholders and technologies within provider groups to support key initiatives and strategies.
- Improves provider organization performance through data analysis, knowledge of best practices, and development and execution of interventions in collaboration with peers and leaders of contracted healthcare delivery systems.
- Serves as a Subject Matter Expert on MA programs and objectives such as quality, risk adjustment, and other Medicare programs and stays informed and updated on measures, program changes and quality gap closure processes. Establishing credibility as a trusted advisor and resource to influence positive change while imparting a great company image and professional demeanor.
- Develops and deploys best-practice network incentives/recognition. Participates in internal workgroups to support development of effective member and provider network-directed interventions; coordinates interventions with internal stakeholders.
WHAT YOU BRING:
- Demonstrated knowledge of medical group/IPA operations, integrated delivery systems, and health plans, as well as industry trends, challenges and solutions as they relate to improved performance in Medicare
- Knowledge of provider coding, documentation practices, reimbursement and contract methodologies
- Demonstrated acumen identifying problems, developing solutions, and implementing a chosen course of action to resolve issues and build consensus among groups of diverse stakeholders. Ability to develop and drive new initiatives from concept through execution, including developing, managing and leading complex projects.
- Demonstrated ability to develop relationships quickly and leverage working relationships to drive performance outcomes. Excels at working with all levels of staff, within and external to the organization, to achieve goals.
- Strong written and verbal communication and facilitation skills, excellent presentation and public speaking skills (formal and informal)
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
- medical, dental, and vision coverage for employees and their eligible family members
- annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
- paid time off varying by role and tenure in addition to 10 company holidays
- up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
- up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
- one-time furniture and equipment allowance for employees working from home
- up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
If you need accommodation for any part of the application process because of a medical condition or disability, please email Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.
