Provider Performance Specialist II

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

📋 Description

• Offer consultative support to providers aimed at enhancing performance in member outreach, utilization management, cost, quality, and risk.

• Analyze, discuss, and interpret performance reporting, member engagement data, and other data resources to uncover opportunities for improving member outcomes.

• Interpret performance metrics and prioritize actionable insights.

• Create discussion and presentation documents that include year-to-date results, month-over-month performance, and member engagement outcomes.

• Lead provider discussions regarding opportunities for improvement in quality, utilization, cost, or risk performance using corporate tools and reports.

• Work in collaboration with the health plan quality counterpart to ensure aligned communication and goals for provider discussions.

• Gain expertise in tools and value-based performance (VBP) and educate providers on their usage and data interpretation.

• Present comprehensive HBR (Health Benefits Ratio) analyses and prepare reports for Joint Operating Committee meetings.

• Execute other assigned duties as necessary.

• Adhere to all policies and standards.

⛳️ Requirements

• Must possess authorization to work in the U.S. without requiring employment-based visa sponsorship, either now or in the future.

• Bachelor’s degree in a relevant field or equivalent professional experience.

• Minimum of 2 years of combined experience in managed healthcare and provider reimbursement.

• Experience in claims processing and/or managed care is preferred.

• A valid state clinical license is preferred for Fidelis Care NY only (e.g., LPN, RN).

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off along with holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive opportunities may be included in the overall compensation package.