Practice Performance Advisor

Amerihealth Caritas•Southfield, MI

3d•Remote

About The Position

The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.

Requirements

Bachelor’s degree in healthcare administration or related field required
3 years of Account Executive experience or provider engagement experience, demonstrating knowledge of TCOC and Medical Loss Ratio (MLR) analysis, is required.
Experience in a variety of provider reimbursement methodologies, including value-based or risk-based contracting
Understand quality and provider performance reporting, including HEDIS and other quality measures.
Valid driver's license, transportation, and insurance required:
Strong understanding of healthcare regulations, reimbursement models, and quality metrics, specifically in HEDIS and STARS
Ability to analyze and interpret complex healthcare data and translate insights into actionable strategies
Knowledge of provider operations, including claims coding, payment integrity, credentialing, appeals, and disputes
Experience working with value-based care programs and performance measures
Excellent communication and collaboration skills with the ability to engage providers and cross-functional teams
Strong analytical, problem-solving, and reporting capabilities
Ability to manage multiple priorities and drive performance improvement initiatives

Responsibilities

Produce all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for the Joint Operating Committee (JOC).
Present information to the provider, colleagues, and the executive team in a clear, concise manager
Analyze claims data, utilization trends, and patient outcomes to support performance optimization
Support provider engagement related to Healthcare Effectiveness Data and Information Set (HEDIS), Total Cost of Care (TCOC), and other performance-based programs
Partner with Quality, Provider Network, and Account Executive teams to align strategies and improve provider performance
Participate in provider meetings to review gaps in care and develop action plans in collaboration with Provider Network Management (PNM) and Chief Medical Officer (CMO) teams
Lead and support performance improvement initiatives and projects aligned with corporate strategy and best practices
Identify opportunities using data and collaborate with internal teams to develop and implement targeted intervention strategies
Track, monitor, and report on provider action plans and outcomes to measure the effectiveness of initiatives
Support network and quality strategy execution across markets
Maintain strong cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality teams to achieve performance goals
May assist with member outreach efforts and coordination of care-related activities