Manager, Provider Performance Engagement

CareSource•Ohio WFH, OH

2d•$83,000 - $132,800

About The Position

The Manager, Provider Performance Engagement oversees performance engagement activities with internal and external partners, focusing on improving health outcomes and total cost of care. The role aligns provider interventions with customized Alternative Payment Model (APM) engagement plans, oversees implementation, assesses results, and guides improvement opportunities. It manages provider engagement plans, onboarding and oversight processes, regulatory compliance, analysis of program and financial outcomes, and reporting to stakeholders. The manager also leads staff, supports career growth, and aligns department priorities with market and corporate goals.

Requirements

Bachelor's degree or equivalent years of relevant work experience.
At least five years of experience working collaboratively with external Health Partners.
Familiarity with the healthcare field and experience with payer-provider integration.
Proficiency with Microsoft Office tools, including Project, Word, and Excel.
Thorough understanding of project management processes, techniques, and tools.
In-depth knowledge of regulatory and quality standards and measures, including State Medicaid programs, Medicare, and quality accreditation (e.g., ODM, CMS, NCQA, URAC).
In-depth knowledge of Patient Centered Medical Home (PCMH) concepts and processes.
Ability to communicate before individuals, groups, and executive leadership.
Ability to interact effectively with all levels of management.
Flexibility during organizational or business changes.
Strong analytical and collaboration skills, and a sense of urgency.
Exceptional emotional intelligence.
Excellent written and verbal communication skills.
Strong interpersonal and relationship-building skills.
Ability to work independently and within a team environment.
Ability to multitask and prioritize work to meet project deadlines.
Effective listening and critical thinking skills.
Time management skills.
Customer-service orientation.
Decision-making and problem-solving skills.
Excellent planning, negotiating, and influencing skills.
Annual proof of Influenza vaccination is required for designated positions during Influenza season (October 1–March 31). Employees hired during the season have 30 days from hire to complete the vaccination and verify immunization records.

Nice To Haves

Master’s degree in business or a health-related field.
At least one year of leadership or management experience.

Responsibilities

Conduct internal and external meetings to establish and execute detailed provider performance engagement plans for new and existing providers.
Manage customized provider plans that support key quality metrics and positive outcomes.
Manage process development activities for provider onboarding and oversight.
Ensure compliance with state, federal, and regulatory body requirements.
Assist with developing and maintaining departmental policies and procedures for oversight of contracted providers in an Alternative Payment Model (APM).
Analyze, update, and modify procedures to continually improve engagement processes.
Review and incorporate data analysis for program metrics, outcome measures and results, and savings opportunities.
Support and manage financial ROI, quality metrics, and service level agreements to evaluate provider engagement initiatives.
Identify and manage risks associated with process changes, implement mitigation strategies, and communicate or escalate risks to stakeholders.
Report provider APM program progress and oversight status to stakeholders.
Ensure provider performance engagement milestone deliverables are completed for each project phase.
Maintain strategic alignment when prioritizing projects by following the established RACI document and ensuring appropriate stakeholder engagement.
Participate in Provider Oversight Committee meetings with internal business owners and providers.
Provide leadership guidance to support staff career growth.
Oversee staff day-to-day activities to ensure department goals are achieved.
Manage department staff objectives and priorities to align with market and corporate goals.
Perform other job-related instructions as requested.