Manager, Provider Performance Engagement

🕒 October 14

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $83k - $132.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

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

🎯 Requirements

• Must reside in Ohio • Bachelor's degree or equivalent years of relevant work experience required • Minimum of five (5) years of experience working collaboratively with external Health Partners required • Familiarity with the healthcare field and experience with payer-provider integration required • Master's degree in business or health related field preferred • Minimum of one (1) year leadership/management experience preferred • Proficient in 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 • Excellent written and verbal communication skills • Strong interpersonal and relationship building skills • Ability to work independently and within a team environment • Ability to multi-task and prioritize work to meet project deadlines • Effective listening and critical thinking skills • Time management skills • Customer service oriented • Decision making/problem solving skills • Excellent planning, negotiating and influencing skillset • Annual Influenza vaccination required during Influenza season as a condition of continued employment

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Annual Influenza vaccination requirement and immunization support • Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs • General office environment with potential to sit or stand for extended periods