Provider Performance Specialist-Senior

Occasionally

• This is a remote position in which we are able to employ in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
• JOB SUMMARY/PURPOSE
• Provides advanced leadership in provider performance management and network optimization. Manages strategic provider relationships, leads complex performance initiatives, and serves as a senior escalation resource supporting the Plan Performance provider operating model.

DEPARTMENT DESCRIPTION
• Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

EXPERIENCE/EDUCATION/QUALIFICATIONS
• Bachelor’s degree in Healthcare Administration, Public Health, Health Informatics, or a related field, or equivalent related experience required.
• Four (4) years of experience in a healthcare payer, integrated delivery system, ACO, or value-based care environment required.
• Experience with the following tools required:
• Excel (advanced).
• Power BI/Tableau or similar visualization platforms.

Experience in the following preferred:
• Population health or analytics platforms.
• Designing or improving provider workflows, performance improvement initiatives, or cross functional operational processes.
• Managed care leadership, with experience supporting D-SNP or dual-eligible populations.
• Delegated UM, delegated credentialing, or managing leased network environments.

Lean Six Sigma or process improvement certification preferred.

KNOWLEDGE/SKILLS/ABILITIES
• Healthplan and regulatory expertise, including working knowledge of Medicare Advantage program operations, Medicaid/CCO performance programs, CMS regulatory frameworks, NCQA accreditation and quality program expectations, delegated oversight model concepts, and provider network performance management
• Strong analytical and executive communication skills. Ability to use data storytelling to influence physician behavior.
• Ability to interpret healthcare performance data and translate into provider action.
• Ability to analyze dashboards including HEDIS / STARs measures, Risk Adjustment (RAF/HCC) Performance, Access and Utilization Metrics, and Provider Experience Indicators.
• Ability to identify performance drivers and root causes across clinical and operational workflows.
• Working knowledge of Risk Adjustment methodology (HCC/RAF concepts), documentation and recapture workflows, annual visit/wellness visit operational models, and preventative chronic care quality improvement strategies.

PHYSICAL DEMANDS
• Rarely (1 - 10% of the time)
  

Frequently

(34 - 66% of the time)

Continually

(67 - 100% of the time)

CLIMB - STAIRS

LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

LIFT (Knee to chest: 24"-54") 0 - 20 Lbs

LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

BEND FORWARD at waist

KNEEL (on knees)

STAND

WALK - LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

SIT

CARRY 2-handed, 0 - 20 pounds

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist