Manager, Provider Network Performance

Job Summary:

The Manager, Provider Network Performance provides leadership and direction to staff to ensure the goals of the department are successfully achieved.

Essential Functions:

• Ensure accurate and timely implementation of new Value Based Reimbursement (VBR) initiatives
• Lead value-based reimbursement team projects focused on the continued development and automation of VBR programs
• Assist in development of action plans throughout the business and establish control plans for implemented projects
• Work collaboratively and lead initiatives with various business units in identification, definition and communication of process metrics
• Prepare plans to track project performance and assure timely completion and achievement of project deliverables
• Identify and document opportunities for improvement with markets and business units as well as internally to the department
• Report and communicate the results from process improvement efforts to leadership
• Perform capability diagnostics utilizing process improvement tools, available metrics and business rules
• Responsible for robust competitor and provider competitive analysis and the creation of other information to formulate a business decision related to the provider network, defining gaps between current state and industry best practices
• Design future state network performance models that addresses opportunities uncovered during current state analysis
• Determine and document the impact of change on cross functional processes and collaborates with cross functional teams to address the associated risks of change
• Define and install processes, tools, and systems that allow for and support formal VBR reporting architectures, KPI controls and network performance transparency
• Perform Business Process Mapping – Current State and To-Be concepts and processes
• Research and make recommendations on new innovation around VBR and development of new initiatives
• Work with Senior Management to strategize and coordinate development of future VBR programs
• Develop enhanced VBR program tracking and reporting
• Develop and report on key accomplishments and issues to upper management
• Responsible for hiring, training and developing staff effectively, while ensuring a strong, competent and talented team of high integrity professionals
• Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree in Business Administration, or related field is required
• Three (3) years of provider operations experience is required
• Minimum one (1) year of management experience is required
• Provider contracting experience is preferred

Competencies, Knowledge and Skills:

• Proficient with Microsoft Office to include Word, Excel and PowerPoint
• Excellent written and verbal communications skills
• Ability to develop, prioritize and accomplish goals
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Effective problem-solving skills with attention to detail
• Ability to work independently and within a team
• Excellent leadership skills
• Ability to create and maintain excellent working relationships
• Ability to lead and direct the work of others including the development, motivation and rewarding of staff

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to travel occasionally

Compensation Range:
$79,800.00 - $127,600.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies: