Provider Performance Specialist Senior

Corewell Health • $80K — $95K *
Grand Rapids, MI 49504In-Person
Healthcare
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in healthcare administration, business administration, accounting, finance, clinical, or health and human services, or equivalent experience
  • 5 years of relevant experience in provider network management, healthcare insurance, or related healthcare delivery settings
  • 2 years of relevant experience in a clinical environment
  • Master's Degree in healthcare administration, business administration, or a related field preferred
  • Proven experience analyzing financial and outcomes data
  • Knowledge of Patient Profiles and reporting programs like RPX
  • Intermediate proficiency in Microsoft Office Suite

Responsibilities

  • Develop and execute provider strategy and solutions for Accountable Care Networks
  • Manage relationships and oversight in value-based contracts
  • Collaborate with interdisciplinary teams for successful engagement
  • Lead implementation of payment programs aligned with business strategy
  • Drive down total cost of care through utilization and expense oversight
  • Assess risk readiness for accountable care networks
  • Analyze monthly reports to manage contract success
  • Propose solutions to close gaps and achieve quality metrics

Benefits

  • Full-time employment with day shifts (Monday to Friday)
  • Commitment to strategic goals and quality improvement
  • Collaborative work environment with interdisciplinary teams
  • Opportunity to influence provider performance and cost efficiency
  • Role focused on innovative payment models and health outcomes
Full Job Description
Job Summary

Drive provider network strategies and solutions to improve outcomes and decrease medical expense trends. Develop and implement network engagement strategies linking strategic goals to the execution and renewal of alternative payment model contracts, through medical expense and utilization oversight of trend variance. Advance the requirements of business and quality improvement plans for assigned Accountable Care Networks and large practice groups.

Essential Functions

  • Responsible for contributing to the development and execution of provider strategy and solutions for assigned Accountable Care Networks. Substantially responsible for the execution of the strategy, including implementation of an annual strategic plan; coordinating and managing overall activities and developing strategies and approaches to help providers maximize performance potential
  • Provide relationship management and accountable care network oversight to support success in value based contracts
  • Actively contribute to the InterDisciplinary Teams to ensure successful engagement of all parties
  • Lead the execution and implementation of payment programs, aligning economics with the business strategy to achieve lower per capita cost
  • Manage and implement programs to drive down total cost of care through utilization and medical expense trend oversight
  • Identify risk readiness for accountable care networks
  • Manage contract success through analysis of monthly reports
  • Provide mitigation solutions for gap closure and quality metric success


Qualifications

Required

  • Bachelor's Degree in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience
  • 5 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting


  • 2 years of relevant experience directly interacting in a clinical environment


Preferred
  • Master's Degree Master's degree in health care administration or business administration or other relevant degree
  • Proven experience analyzing and assimilating financial and outcomes data
  • Knowledge of Patient Profiles and RPX reporting, and/or other reporting programs
  • Experience delivering presentations to a variety of audiences
  • Intermediate level knowledge of Microsoft Office Suite


Primary Location
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids

Department Name
Provider Network Management - PH Managed Benefits

Employment Type
Full time

Shift
Day (United States of America)

Weekly Scheduled Hours
40

Hours of Work
8 a.m. to 5 p.m.

Days Worked
Monday to Friday

Weekend Frequency
N/A

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About Corewell Health

Corewell Health Careers

Joining Corewell Health presents an unparalleled opportunity to become part of a leading team of healthcare professionals dedicated to excellence. Corewell Health is renowned for its commitment to innovation, leadership, and providing superior healthcare services.

Explore Job Opportunities

Corewell Health is actively seeking talented individuals who are eager to contribute to a dynamic healthcare environment. The company offers a variety of job opportunities that cater to a range of skills and experiences. Whether you're a seasoned professional or a recent graduate, Corewell Health has a position that could be the perfect fit for your career ambitions.

Internship Programs

For those just starting their professional journey, Corewell Health provides robust internship programs designed to foster skills development and offer real-world experience in the healthcare industry. Internships at Corewell Health are a stepping stone to full-time employment and offer invaluable networking opportunities within the healthcare sector.

Growth and Development

Career growth is a cornerstone of employment at Corewell Health. The company supports its team members' professional development through comprehensive training programs, including leadership training and diversity training. These initiatives ensure that every team member has the tools and knowledge necessary to excel in their roles and advance within the company.

Benefits and Culture

Corewell Health is committed to creating a workplace culture that values diversity and inclusion. Employees enjoy a competitive package of benefits that supports both their professional and personal lives. The company's culture promotes teamwork and respect, making it an ideal environment for those who value collaboration and innovation.

Hiring Process

The hiring process at Corewell Health is designed to be transparent and efficient. Candidates are encouraged to submit a resume and may be invited for an interview to discuss their qualifications and career goals in more detail. Corewell Health values a thorough approach to ensure that all potential team members align with the company’s values and vision for the future.

Networking and Professional Development

Corewell Health believes in the power of networking and encourages its employees to engage with one another and the broader healthcare community. This engagement fosters a sense of community and collaboration, which is critical in the fast-paced world of healthcare.

Join the Team

Corewell Health is continuously looking for passionate, curious, and solution-driven individuals to join their ranks. Explore the open positions at Corewell Health by searching their Jobs and Careers page. Discover how your expertise and ambitions can contribute to the transformative work happening at Corewell Health.

Stay Connected

Keep up to date with the latest from Corewell Health by following their Careers Blog. Gain insights from insiders, learn more about the company culture, and stay informed about new job openings and company news.

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Personalize your subscription to receive job alerts and insider tips directly from Corewell Health. Tailor your preferences to see what exciting and rewarding opportunities await in the field of healthcare. By joining Corewell Health, individuals are not just finding a job; they are stepping into a career filled with potential for growth, professional development, and the chance to make a significant impact in the healthcare industry.
Learn more about Corewell Health
Industry
Hospitals & Medical Centers
* Ladders Estimates

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