Provider Performance Manager

Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
  
  

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

The Provider Performance Manager PPM at Community Health Choice serves as the lead in establishing and supporting a collaborative, innovation-focused relationship with participating practice groups. The primary goal of this role is to optimize practice performance in a value based and/or risk-based environment and assess it against industry standards. The PPM will collaborate internally with various departments, including Credentialling, Medical Affairs, and Technology Platform. Externally, they will work with payer representatives and community partners.

JOB SPECIFICATIONS AND CORE COMPETENCIES

Lead And Manage Provider Group Practices

• Lead and manage small and mid-size provider group practices, overseeing approximately 50,000 members.
• Train and educate practices on practice transformation activities outlined in Community's Provider Performance Management (PPM) and Practice Transformation Playbook.
• Ensure alignment of practice operations with the key elements of Community's Care Model.
  
  

Maximize Population Health Outcomes And Provider Satisfaction

• Implement Community’s Practice Transformation Playbook, Pillars of Care, Salesforce Portal, HER integration, and interoperability innovations to maximize population health outcomes, member experience, and provider satisfaction.
• Influence behavioral changes in provider practice operations based on industry best practices and key Community practice transformation modules and resources.
• Facilitate training on Cultural Care, HEDIS, STARS, and RAF, as well as practice improvement and performance monitoring.
  
  

Drive Practice Improvement And Transformation

• Establish regular meeting cadence with assigned provider practices to ensure progress on practice transformation and improvement activities, as evaluated by improvement in ECIP earnings, HEDIS and STARs metrics, and other contract goals and value-based activities.
• Develop and drive improvement plans measured by cost, quality outcomes, and provider satisfaction.
• Support activities to achieve the overall strategy and objectives of Quality/Population Health department and ensure contractual requirements are met at a practical level.
  
  

Relationship Building And Collaboration

• Serve as the primary point of contact for all other Community subject matter experts interfacing with the provider practice and its staff, engaging them as needed to support practice improvement.
• Develop and strengthen relationships with various provider groups, using influence and leadership competencies to help transform the practice toward value-based care.
• Assume ownership of the post-recruitment phase of the practice cycle and responsibility for project leadership to achieve successful completion, integration, or implementation of various initiatives.
  
  

Data Analysis And Reporting

• Deliver operational reports (scorecards) to the practice/providers, utilizing data analysis techniques to convey opportunities for remediation and influence needed practice changes.
• Identify operational workflows needing remediation and present solutions, escalating to Community leadership collaborators and the Executive team as needed to resolve issues.
• Ensure accurate documentation and maintenance of provider and practice information.
  
  

Other Duties

• Perform other duties as assigned to support the overall functioning of the department.
  
  

Qualifications

Education/Specialized Training/Licensure:

• Bachelor's degree in business, healthcare administration, or a related field of study.
• Or
• 7 years’ experience in lieu of degree (Must be the equivalent combination of required education and minimum experience.)
  
  

Work Experience (Years And Area)

• Minimum of three (3) years of experience in the healthcare industry, preferably with healthcare network operations and/or practice management with degree.
• Minimum of seven (7) years of experience in the healthcare industry, preferably with healthcare network operations and/or practice management without bachelor’s degree.
  
  

Software Proficiencies: Proficiency with Microsoft Office applications and web-based technologies.

Other

• Demonstrated understanding of risk and value-based contracting.
• Strong provider relations skills and experience.
• Familiarity with payment alternatives such as fee for service, capitation, global budget, performance compensation and episode of care payment.
• Knowledge of patient and practice risk adjustment mechanics and premium-based payment methodologies.
• Demonstrated ability to gain acceptance and compliance from providers and staff to achieve a mutually beneficial outcome.
• Excellent problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
• Ability to convey complex or technical information in a manner that others can understand, and ability to understand and interpret complex information from others.
• Successful record of managing multiple projects with demonstrated ability to work independently in rapidly changing environments.