Director, Provider Performance

Company: American Health Quality Association
Location: Houston
Posted on: September 1, 2024

Job Description:

JOB SUMMARY The Director provides strategic leadership in the development, direction, execution, and evaluation of an effective provider performance program. The Director is responsible for assuring the program supports the delivery of quality and growth outcomes through collaborative, innovation-focused relationship with participating practice groups. The goal of this department is to optimize practice performance in a value-based and/or risk-based environment and assess against industry standards. In addition, the Director develops systems to ensure effective coordination between all functions within the health plan to meet the needs of the network providers. Establishing effective processes within the health plan operations. JOB SPECIFICATIONS AND CORE COMPETENCIES Strategic Planning:

• Collaborates with key departments to develop provider performance targets that meet the strategic objectives of the organization.
• Develops and maintains a Community Practice Transformation Playbook.
• Establish innovations to drive provider practice performance.
• Identify improvement opportunities that will drive outcomes for providers and the organization.
• Monitors and reports significant developments occurring within the provider community and assists in developing a strategic plan to mitigate risks and capitalize on opportunities.
• Establishes and updates as needed CHC provider performance policies and procedures and CHC provider contractual materials.
• Monitors the outcomes metrics for the network's performance. Departmental Management:
  • Assists in the development of annual departmental budgets and monitors expenditures to meet administrative cost targets.
  • Ensures all related operations, communications, and daily interactions with providers remain compliant with regulatory and accreditation standards.
  • Ensures timely and accurate submission of related regulatory and compliance reports associated with the provider performance.
  • Monitors the provider landscape to ensure Community?s is competitive. Cross-functional Duties:
    • Works with the Finance, Analytics, Quality, Provider Operations, Medical Affairs, and Executive Team as needed to make essential data-driven decisions.
    • Actively contributes to achievement of departmental goals, as identified in Department?s annual business plan, including specific departmental process improvement plan, and other duties as assigned. QUALIFICATIONS: Education/Specialized Training/Licensure:
      • BA/BS; 4 years equivalent work experience may substitute for degree requirement.
      • Work Experience (Years and Area): 7 years in healthcare, with at least 5 years experience in Providers/Managed Care Contracting. Medical contract negotiations experience.
      • Health Plan experience, Experience within the Houston market. Management Experience (Years and Area): 4 years direct supervision experience required. Software Proficiencies: Microsoft Office Suite Other: Must have car and valid Texas Driver?s license Contracting experience with hospital and physician practice (group practice & solo practitioner) required. Developing and implementing strategic objectives for the contracting function. Experience implementing provider incentive programs and pay-for-quality programs, claims payment and CRM systems. Demonstrated ability to manage and develop staff in medical contract negotiation. Experience with QNXT and Salesforce.
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Keywords: American Health Quality Association, Houston , Director, Provider Performance, Executive , Houston, Texas