Manager, Provider Network Performance - CareSource

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:
- 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.