The Provider Engagement leader develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement leader works on problems of diverse scope and complexity ranging from moderate to substantial.
The Provider Engagement leader represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
**INCUMBENT MUST RESIDE IN SALT LAKE CITY METRO AREA.
Job Functions
Responsible for Practice Engagement
Training staff on programs, technology and processes.
Onboarding new practices.
Improving performance of practices.
Evaluate practice workflow
Review and analyze data and make recommendations
Responsible for performance management
Required Qualifications
A minimum of five years of healthcare or managed care experience, preferably in a primary care practice
Operational experience with managing value-based contracts, population health, or other healthcare performance improvement
Proven planning, preparation and presenting skills, with established knowledge of clinician reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines
Comprehensive knowledge of all Microsoft Office applications
Ability to operate independently in support of this market.
STARS experience
Proven success in managing Value Based Care contracts.
Experience in MSO, Payor Org.
Experience in Medicare Risk Adjustment, Cost Management, Utilization Management.
Advanced organizational skills and/or project management
Ability to travel as needed
Preferred Qualifications
Bachelor and/or Master's Degree
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses, and quality/bonus performance
Comprehensive knowledge of Medicare policies, processes, and procedures
Additional information
Remote Role
Incumbent must be based in Salt Lake City, UT metro area
Role requires