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Director, Provider Performance Engagement
CareSource. Shape and implement strategies that enhance members' quality of care and lead transformational change in the market .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in leading behavioral health strategies, managing provider compliance, and implementing Alternative Payment Model agreements. Proven ability to enhance quality of care through effective team leadership, analytical problem-solving, and strong communication skills.
Highest-signal resume keywords
Leadership/Management ExperienceClinical Experience in Healthcare DeliveryKnowledge of APMs and Behavioral HealthProvider Compliance and Contracting ManagementStrong Organizational and Analytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ExperienceCase ManagementPopulation Health ManagementQuality ImprovementProvider ContractingRegulatory Standards KnowledgeAPM ImplementationHealthcare Delivery OversightBehavioral Health Strategy DevelopmentPerformance Analysis
Soft Skills
Exceptional Oral and Written CommunicationCollaboration and Relationship BuildingProblem-SolvingAdaptability to Shifting PrioritiesCoaching and Development
Tools & Technologies
Microsoft Office SuiteMobile Communication Devices
Certifications & Qualifications
Current, Unrestricted RN LicenseValid Driver's License
Industry Keywords
Care CoordinationQuality AccreditationState Medicaid ProgramsMedicareNCQAURACHEDIS
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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