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 (hourly/salary):Salary

Organization Level Competencies

Create an Inclusive Environment

Cultivate Partnerships

Develop Self and Others

Drive Execution

Influence Others

Pursue Personal Excellence

Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

R7339

Remote/Remotely/Tele/Telecommute/From home