Provider Performance Director, Medicare Advantage

Company: Cambia Health Solutions, Inc
Location: Renton
Posted on: May 7, 2024

Job Description:

Provider Performance Director, Medicare Advantage (HEALTHCARE)Telecommute or Tele-Flex Options (Depending on location) - Must reside in ID, OR, UT or WAWHO WE NEEDAre you a strategic leader with a passion for driving improvement in healthcare? Do you have experience in provider engagement and performance management? We're searching for a talented Government Programs Provider Performance Director to join our team!As a Government Programs Provider Performance Director, you'll develop provider engagement strategies to drive performance improvements in critical objectives such as population health management, Medicare Stars, and Risk Adjustment.Here are some of the exciting responsibilities you'll have:Analyzing Performance Data: You'll analyze performance data to identify areas for improvement and set targets for provider performance.Communicating Improvements: You'll communicate improvements and best practices to providers, enabling them to deliver high-quality care to Regence members.Innovative Interventions: You'll identify innovative interventions to support provider practice transformation and meet the needs of Regence members.Strategies and Initiatives: You'll 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.If you're a strategic thinker with a passion for driving improvement in healthcare, we want to hear from you! Apply now and join our team as a Government Programs Provider Performance Director!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 modelsNormally 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)

Keywords: Cambia Health Solutions, Inc, Everett , Provider Performance Director, Medicare Advantage, Executive , Renton, Washington