Director, Provider Performance Engagement

Job not on LinkedIn

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Shape and implement strategies that enhance members' quality of care and lead transformational change in the market • Lead implementation of Alternative Payment Model (APM) agreements • Ensure provider performance and engagement comply with CareSource provider agreements, ODM, and CMS requirements • Lead development and execution of CareSource's Behavioral Health strategy • Coordinate assessment of provider APM level and readiness • Analyze gaps in care and advance providers along the care coordination continuum with regional teams • Contribute to APM quality and performance programs aligned with Quality, Contracting, and Network Performance • Oversee behavioral health provider performance and relations operations • Participate in and lead All-Plan quality withhold and regulatory programs and initiatives • Partner with Provider Network Performance to meet quality, performance, and financial contract specifications • Lead development and maintenance of departmental policies and procedures • Design and implement provider engagement strategies to improve quality, member satisfaction, population health, and healthcare costs • Perform other job-related duties as requested

🎯 Requirements

• Bachelor's in nursing, business, health administration, health policy, or related discipline required • Equivalent years of relevant work experience may be accepted in lieu of required education • Five (5) years of clinical experience in healthcare delivery and oversight required • Five (5) years of leadership/management experience required • Five (5) years of experience in case management and/or population health preferred • Experience in managing provider compliance and contracting preferred • Experience speaking before individuals and groups, vendors, and executive leadership preferred • Comprehensive knowledge of APMs, behavioral health, case management, medical management, and quality improvement • Strong organizational, analytical, and problem-solving skills • Exceptional oral and written communication skills • Proven leadership capabilities focused on collaboration and relationship building • Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel • Proficiency with smartphones or other mobile communication devices • Knowledge 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 provider operations • Ability to manage a high-performing team and provide coaching and development • Ability to interact with all levels of leadership and lead cross-functional teams and initiatives • Ability to recognize opportunities for improvement, handle complex responsibilities, and lead change • Ability to adjust to shifting priorities, multitask, work under pressure, and meet deadlines • Current, unrestricted license as a Registered Nurse (RN), LPN, Social Worker, or other clinical discipline in state of practice required • Valid driver's license, vehicle, and verifiable insurance required • Successful driver's license record check required • Influenza vaccination required as a condition of continued employment • Ability to travel as required by department needs

🏖️ Benefits

• Bonus tied to 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 and immunization support • Equal opportunity and belonging-focused workplace • Travel as required by department needs