Director, Provider Performance Engagement

CareSource • Ohio WFH, OH

1d • $113,000 - $197,700 • Onsite

About The Position

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.

Requirements

• Bachelor's in nursing, business, health administration, health policy or related discipline required
• Five (5) years of experience clinical experience in healthcare delivery and oversight is required.
• Five (5) years of leadership/management experience required
• 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.
• Influenza vaccination is a requirement of this position.

Nice To Haves

• 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 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
• 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

Responsibilities

• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director