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Provider Performance Director, Medicare Advantage (HEALTHCARE)

Telecommute or Tele-Flex Options (Depending on location) - Must reside in ID, OR, UT or WA

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.
  • Leverages Medicare Quality Incentive Program to promote provider-focused use of available resources and tools to improve member health outcomes. Monitors progress and creates awareness of course corrections when needed.
  • Monitors supplemental data exchange strategy between provider groups and the company to support the improvement in performance measures for the Stars program
  • Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
  • Develops strategies to increase provider engagement on MA objectives by articulating the value proposition and mutual benefits to improve member health outcomes and MA performance.
  • Develops and manages execution of communication and messaging strategies in pursuit of objectives and initiatives.
  • Assesses and communicates project status, key business risks and vulnerabilities to leadership. Recommends and implements appropriate action steps and coordinates with internal teams to follow through to close action plans. Develops and oversees monitoring and reporting procedures to ensure deliverables and budget are on track. 
  • As a Network Management team member - lead, participate, and contribute to internal committees/workgroups as assigned; act as a mentor to others within the overall team.
  • Creates a sense of urgency within the organization and translates quickly evolving directions into action.
  • Adheres to all quality, compliance and regulatory standards

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)
  • Demonstrated analytical and problem-solving ability with the skills to interpret and present complex data to all levels of stakeholders internal and external.
  • Demonstrated proficiency with collaboration tools (Teams), presentation, word processing, CRM, reporting and spreadsheet software used to create and maintain databases, spreadsheets, reports and documents.
  • Successful working independently as well as being a strong team leader and contributor. Identifies and distills multiple inputs into priorities and drives results
  • Ability to work in a high-pressure environment and effectively manage conflict and ambiguity.

The expected target hiring range for this position is $135k – $145k depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 20% . The current full salary range for the Provider Performance Director, Medicare Advantage is $124k Low Range / $156k MRP / $203k High Range,.

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.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. 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.

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Confirmed 14 hours ago. Posted 30+ days ago.

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