About the role
Job Summary:
The Director, Provider Performance Engagement is responsible for shaping and implementing strategies that enhance the quality of care of our members, while leading transformational change in the market. This role involves working effectively with all levels of the organization, individuals, and teams across all disciplines to ensure compliance and improve provider performance.
Essential Functions:
Lead the implementation of Alternative Payment Model (APM) agreements, ensuring that provider performance and engagement are functional and compliant with CareSource provider agreements, ODM, and CMS requirements.
Lead the development and execution of CareSource's Behavioral Health strategy, focusing on improving access and quality of care for members.
Coordinate efforts to assess provider APM level and readiness, analyze gaps in care, and work with regional teams to advance providers along the care coordination continuum.
Contribute to the development of APM quality and performance programs to ensure alignment with Quality, Contracting, and Network Performance, providing standardization among provider entities.
Oversee day-to-day operations for behavioral health provider performance and relations, ensuring compliance with all state and business operational, clinical, and program requirements.
Participate in and lead All-Plan activities tied to quality withhold and other regulatory body programs and initiatives.
Partner with the Provider Network Performance team to ensure quality, performance metrics, and financial performance meet contract specifications for all providers.
Lead the development and maintenance of departmental policies and procedures.
Design and implement strategies to increase provider engagement, driving better quality, member satisfaction, improved population health, and reduced healthcare costs.
Perform any other job related duties as requested.
Education and Experience:
Bachelor's in nursing, business, health administration, health policy or related discipline required
Master's of business administration (MBA), Health Administration (MHA), Health Policy or related field preferred
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years of experience clinical experience in healthcare delivery and oversight is required. required
Five (5) years of leadership/management experience required
Five (5) years of experience in case management and/or population health preferred
Experience in managing provider compliance and contracting preferred
Experience speaking before individuals and groups, vendors, and executive leadership preferred
Competencies, Knowledge and Skills:
Comprehensive knowledge of APMs, behavioral health, case management, medical management, and quality improvement.
Strong organizational, analytical, and problem-solving skills.
Exceptional oral and written communication skills, with the ability to engage effectively with diverse audiences.
Proven leadership capabilities with a focus on collaboration and relationship building.
Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel
Proficient with other technologies such as smartphone or other mobile communication devices
Knowledge of and application of regulatory standards and measures including but not limited to State Medicaid Programs, Medicare, and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.), quality improvement and HEDIS programs/outcomes measurement
Knowledge of provider contracting and familiarity with provider operations
Excellent leadership skills, with ability to effectively manage a high performing team, and provide coaching and development
Excellent oral, written, and interpersonal communications skills to effectively interact, exercise discretion, judgement and diplomacy when dealing with internal and external customers
Ability to interact with all levels of leadership, and lead cross-functional teams and initiatives
Ability to recognize opportunities for improvement, handle complex responsibilities, and lead change
Highly motivated individual with the ability to adjust to shift priorities, multi-task, work under pressure and meet deadlines
Licensure and Certification:
Current, unrestricted license as a Registered Nurse (RN), LPN, Social Worker, or other clinical discipline in state of practice required
Must have valid driver's license, vehicle and verifiable insurance. Employment in this position 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, if employee has started employment in position, employment in this position will be terminated
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Ability to travel as required by the needs of the department.
Compensation Range:
$113,000.00 - $197,700.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Brand=CareSourceOriginally posted on Himalayas