Provider Network Performance Manager

🕒 vor 1 Monat

🏖️ New Jersey – Remote

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💵 $60.000 - $115.000 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

👔 Manager

👻 Geisterscore 12%

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🗣️🇺🇸🇬🇧 Englisch erforderlich

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Devoted Health

1001 - 5000 Mitarbeiter

Gegründet 2017

🏥 Gesundheitswesen

⚕️ Krankenversicherung

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health ist ein Gesundheitsunternehmen, das Medicare Advantage-Pläne anbietet, die umfassende Gesundheitsvorsorge mit zusätzlichen Leistungen wie zahnärztlichen Behandlungen, Brillen, Fitnessstudio-Mitgliedschaften und verschreibungspflichtigen Medikamenten zu wettbewerbsfähigen Preisen bieten. Das Unternehmen legt großen Wert auf die Unterstützung und Betreuung der Mitglieder, um sicherzustellen, dass Kunden ihre Leistungen problemlos nutzen und die benötigten Gesundheitsdienste in Anspruch nehmen können. Devoted Health verpflichtet sich, Kunden dabei zu helfen, Geld zu sparen und ihre Gesundheit und ihr Wohlbefinden durch ein umfassendes Paket an Leistungen und Unterstützung zu verbessern.

Beschreibung

• Drive provider performance across cost, quality, access, and key network metrics • Identify performance gaps, root causes, and opportunities for improvement • Develop and execute targeted provider performance improvement plans • Monitor results and adjust strategies to drive sustained improvement • Serve as a primary performance partner for assigned physicians, medical groups, health systems, and other providers • Lead regular provider performance reviews and Joint Operating Committees (JOCs) • Build provider relationships while creating accountability for performance expectations and outcomes • Partner with providers to resolve performance issues and remove barriers to improvement • Analyze financial, operational, quality, and provider performance data • Leverage reporting systems, dashboards, and AI-enabled tools to generate insights • Translate complex data into clear recommendations and actionable strategies • Provide leadership with visibility into performance trends, risks, and opportunities • Support contract negotiations and renegotiations, where applicable • Apply fee-for-service, value-based, and risk-based models to support improvements in cost and quality • Evaluate provider and network opportunities through a performance lens • Partner cross-functionally to improve network efficiency, quality, access, and regulatory compliance • Travel approximately 30–40% within the assigned market for provider meetings, relationship building, and market presence

🎯 Anforderungen

• Must be located in New Jersey • 5+ years of experience in managed care, a health plan, or a similar healthcare environment • 5+ years of direct provider-facing experience • Demonstrated experience improving provider performance across cost and/or quality metrics • Strong analytical skills with the ability to translate data into action • Strong provider relationship management, communication, and influencing skills • Ability to work independently, solve complex problems, and drive results • Experience negotiating provider contracts, including physician groups and/or health systems • Experience with value-based or risk-based payment models • Experience in provider performance, network optimization, or healthcare analytics • Ability to travel approximately 30–40% within the assigned market

🏖️ Vorteile

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • 401K program • Parental leave program • Total rewards package for full time employees

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