Director, Provider Performance Engagement

Job Summary:

The Director, Provider Performance Engagement is responsible for shaping and implementing strategies that enhance the quality of care of our members, while leading transformational change in the market. This role involves working effectively with all levels of the organization, individuals, and teams across all disciplines to ensure compliance and improve provider performance.

Essential Functions:
- Lead the implementation of Alternative Payment Model (APM) agreements, ensuring that provider performance and engagement are functional and compliant with CareSource provider agreements, ODM, and CMS requirements.

- Lead the development and execution of CareSource 's Behavioral Health strategy, focusing on improving access and quality of care for members.

- Coordinate efforts to assess provider APM level and readiness, analyze gaps in care, and work with regional teams to advance providers along the care coordination continuum.

- Contribute to the development of APM quality and performance programs to ensure alignment with Quality, Contracting, and Network Performance, providing standardization among provider entities.

- Oversee day-to-day operations for behavioral health provider performance and relations, ensuring compliance with all state and business operational, clinical, and program requirements.

- Participate in and lead All-Plan activities tied to quality withhold and other regulatory body programs and initiatives.

- Partner with the Provider Network Performance team to ensure quality, performance metrics, and financial performance meet contract specifications for all providers.

- Lead the development and maintenance of departmental policies and procedures.

- Design and implement strategies to increase provider engagement, driving better quality, member satisfaction, improved population health, and reduced healthcare costs.

- Perform any other job related duties as requested.

Education and Experience:
- Bachelor's in nursing, business, health administration, health policy or related discipline required

- Master's of business administration (MBA), Health Administration (MHA), Health Policy or related field preferred

- Equivalent years of relevant work experience may be accepted in lieu of required education

- Five (5) years of experience clinical experience in healthcare delivery and oversight is required. 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

Competencies, Knowledge and Skills:
- 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, with the ability to engage effectively with diverse audiences.

- Proven leadership capabilities with a focus on collaboration and relationship building.

- Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel

- Proficient with other technologies such as smartphone or other mobile communication devices

- Knowledge of and application of regulatory standards and measures including but not limited to State Medicaid Programs, Medicare, and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.), quality improvement and HEDIS programs/outcomes measurement

- Knowledge of provider contracting and familiarity with provider operations

- Excellent leadership skills, with ability to effectively manage a high performing team, and provide coaching and development

- Excellent oral, written, and interpersonal communications skills to effectively interact, exercise discretion, judgement and diplomacy when dealing with internal and external customers

- Ability to int