VBC Performance Manager

Position Purpose: Develop strategic partnerships between the health plan and the contracted provider networks serving our communities.

Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution.

Drive optimal performance in contract incentive performance, quality, and cost utilization.

Participate in the development of network management strategies.

Assists in the strategic implementation of new initiatives for performance improvement.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan ensuring a coordinated effort in improving financial and quality performance
• Identify and deliver solutions to providers concerns and issues as needed for resolution to internal partners
• Receive and effectively respond to external provider related issues
• Investigate, resolve and communicate provider claim issues and changes
• Engage with and educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Manages Network performance for assigned territory through a consultative/account management approach
• Evaluates provider performance and develops strategic plan to improve performance
• Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
• Coaches new and less experienced External Reps
• Ability to travel locally 4 days a week
• Performs other duties as assigned