Director, Provider Performance Engagement

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Develop and execute strategies that improve the quality of care for members and drive transformative change in the market.

• Oversee the implementation of Alternative Payment Model (APM) agreements.

• Ensure provider performance and engagement adhere to CareSource provider agreements, ODM, and CMS standards.

• Spearhead the creation and execution of CareSource's Behavioral Health strategy.

• Organize the assessment of provider APM levels and readiness.

• Identify gaps in care and facilitate providers' advancement along the care coordination continuum in collaboration with regional teams.

• Contribute to APM quality and performance initiatives that align with Quality, Contracting, and Network Performance.

• Supervise operations related to behavioral health provider performance and relations.

• Engage in and lead All-Plan quality withhold and regulatory programs and initiatives.

• Collaborate with Provider Network Performance to ensure adherence to quality, performance, and financial contract expectations.

• Drive the development and upkeep of departmental policies and procedures.

• Create and execute provider engagement strategies aimed at enhancing quality, member satisfaction, population health, and reducing healthcare costs.

• Perform additional job-related tasks as necessary.

⛳️ Requirements

• A Bachelor's degree in nursing, business, health administration, health policy, or a related field is required.

• Equivalent years of relevant experience may be considered in lieu of the required education.

• A minimum of five (5) years of clinical experience in healthcare delivery and oversight is required.

• At least five (5) years of leadership or management experience is necessary.

• Five (5) years of experience in case management and/or population health is preferred.

• Prior experience in managing provider compliance and contracting is preferred.

• Experience presenting to individuals and groups, vendors, and executive leadership is preferred.

• In-depth knowledge of APMs, behavioral health, case management, medical management, and quality improvement.

• Strong organizational, analytical, and problem-solving abilities.

• Excellent oral and written communication skills.

• Demonstrated leadership skills focused on collaboration and relationship building.

• Intermediate proficiency in Microsoft Office, including Outlook, Word, and Excel.

• Proficiency in using smartphones or other mobile communication devices.

• Understanding and application of regulatory standards and measures, including State Medicaid Programs, Medicare, Quality Accreditation, ODM, CMS, NCQA, URAC, quality improvement, and HEDIS programs/outcomes measurement.

• Knowledge of provider contracting and operations.

• Ability to lead a high-performing team and provide coaching and development.

• Capability to interact with all levels of leadership and manage cross-functional teams and initiatives.

• Ability to identify opportunities for improvement, manage complex responsibilities, and drive change.

• Adaptability to shifting priorities, multitasking, working under pressure, and meeting deadlines.

• A current, unrestricted license as a Registered Nurse (RN), LPN, Social Worker, or another clinical discipline in the state of practice is required.

• A valid driver's license, vehicle, and verifiable insurance are required.

• A successful driver's license record check is required.

• Annual influenza vaccination is mandatory for continued employment.

• Willingness to travel as necessary based on departmental needs.

🏝️ Benefits

• Bonus linked to both company and individual performance.

• Comprehensive total rewards package.

• Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs.

• Annual influenza vaccination requirement along with immunization support.

• An equal opportunity and belonging-focused workplace.

• Travel as required by department needs.