Provider Network Management Jobs in Michigan

GENERAL SUMMARY:

The Manager of Provider Performance Improvement will be responsible for oversight of provider performance and APM programming, including pay-for-performance planning and value-based contract strategy, overseeing a team tasked with coordinating, achieving, supporting and maintaining performance goals as it relates to quality and cost efficiency measures. Responsible for developing and implementing all initiatives designed to achieve and maintain quality outcomes.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Lead efforts to increase and maximize Quality and cost efficiency outcomes by developing short and long-term strategy across applicable departments that understands the impacts of health care operations, process improvement and business analysis.
• Oversee a team of Quality Provider Performance Liaisons tasked with working directly with provider groups on performance improvement. Supports team in compiling reporting, dashboards, improvement plans, and presentation materials for internal and external audiences.
• Design, implement, and manage comprehensive provider incentives programs in compliance with CMS regulations to improve HEDIS rates, cost efficiency, and APM business goals.
• Oversee and report on interventions for specific quality measures and maintain strategy for measurable impact.
• Provides expertise, direction and coordination of the health plan’s APM programs.
• Present to internal and external leadership and executive boards with overall status reports on scope of oversight including any issues that may impact the organization.
• Participate in quality and population health workgroups as needed with internal and external entities to drive health plan goals/targets as it relates to APM and provider engagement work.
• Lead complex initiatives to a successful conclusion and ensure that project resources are utilized in an effective and efficient manner.
• Develop and maintain positive and mutually beneficial customer relationships with internal (Plan Management, Pharmacy, Customer Service, etc.) and external stakeholders and customers (provider groups, vendors, auditor, etc.).
• Manage vendor relationships as needed.
• Ensures accuracy and compliance with all applicable regulatory requirements.
• Maintain a current knowledge of local, regional, and national efforts and best practices in quality management and APM research, and support efforts to position HAP as a national presence in the field.
• Lead team to meet departmental goals and objectives. Effectively oversee departmental work and responsibilities. Develop, maintain, and improve workflow processes which achieve departmental and HAP targets and timeframes, which positively impact customer satisfaction.
• Support the planning, development and implementation of strategic medical management and/or network management initiatives.
• Coordinate and support improvement activities and optimize efficiencies between the HEDIS and Risk Adjustment teams at HAP.
• Perform other duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree in healthcare, Business Administration or related field.
• Master’s degree in healthcare, Business Administration, Healthcare Administration, Healthcare Policy, Public Health or a related field is preferred.
• Minimum of six (6) years of experience in the health care field, including at least four (4) years of experience in quality measurement, performance outcome improvement, and publicly reported programs.
• Minimum of three (3) years of experience in leading staff in projects or supervisory/management position.
• Minimum of three (3) years of experience with Medicare 5-Star strongly preferred.
• At least four (4) years’ experience in a managed care setting preferred.
• Experience in writing reports for senior leadership and professional audiences.
• Excellent quantitative and qualitative analytical skills.
• Demonstrated verbal and written communication skills at a professional level.
• Ability to work autonomously, cooperatively, and with flexibility in a complex environment.
• Organizational skills to manage multiple projects and frequent changes.
• Ability to persuade, provide direction to, and garner support from others using excellent interpersonal skills.
• Ability to work with minimal supervision, be decisive and achieve goals in expected time frames.
• Knowledge of the health care industry, health maintenance organizations, and health care delivery systems.
• Knowledge of business intelligence applications, data, and tools.
• Knowledge of quality management and measurement principles and techniques in managed care.
• Knowledge of regulatory standards and programs (CMS, NCQA, FEHB, and HEDIS).
• Knowledge of performance improvement methodologies.

Additional Details

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.