Provider Practice Performance Advisor
Amerihealth Caritas Health PlanSouthfield, MI
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Overview
Schedule
Full-time
Career level
Senior-level
Remote
Remote
Benefits
Career Development
Job Description
Role Overview: The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.
Work Arrangements:
- Remote - The associate can be located anywhere in Michigan (MI).
- 50% travel is required to the provider's location and attend office meetings at our Southfield, MI location.
Responsibilities:
- Produce all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for the Joint Operating Committee (JOC).
- Present information to the provider, colleagues, and the executive team in a clear, concise manager
- Analyze claims data, utilization trends, and patient outcomes to support performance optimization
- Support provider engagement related to Healthcare Effectiveness Data and Information Set (HEDIS), Total Cost of Care (TCOC), and other performance-based programs
- Partner with Quality, Provider Network, and Account Executive teams to align strategies and improve provider performance
- Participate in provider meetings to review gaps in care and develop action plans in collaboration with Provider Network Management (PNM) and Chief Medical Officer (CMO) teams
- Lead and support performance improvement initiatives and projects aligned with corporate strategy and best practices
- Identify opportunities using data and collaborate with internal teams to develop and implement targeted intervention strategies
- Track, monitor, and report on provider action plans and outcomes to measure the effectiveness of initiatives
- Support network and quality strategy execution across markets
- Maintain strong cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality teams to achieve performance goals
- May assist with member outreach efforts and coordination of care-related activities
Education & Experience:
- Bachelor's degree in healthcare administration or related field required
- 3 years of Account Executive experience or provider engagement experience, demonstrating knowledge of TCOC and Medical Loss Ratio (MLR) analysis, is required.
- Experience in a variety of provider reimbursement methodologies, including value-based or risk-based contracting
- Understand quality and provider performance reporting, including HEDIS and other quality measures.
Licensure:
- Valid driver's license, transportation, and insurance required:
Skills & Abilities:
- Strong understanding of healthcare regulations, reimbursement models, and quality metrics, specifically in HEDIS and STARS
- Ability to analyze and interpret complex healthcare data and translate insights into actionable strategies
- Knowledge of provider operations, including claims coding, payment integrity, credentialing, appeals, and disputes
- Experience working with value-based care programs and performance measures
- Excellent communication and collaboration skills with the ability to engage providers and cross-functional teams
- Strong analytical, problem-solving, and reporting capabilities
- Ability to manage multiple priorities and drive performance improvement initiatives
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FAQs About Provider Practice Performance Advisor Jobs at Amerihealth Caritas Health Plan
What is the work location for this position at Amerihealth Caritas Health Plan?
This job at Amerihealth Caritas Health Plan is located in Southfield, MI, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Amerihealth Caritas Health Plan?
Employer has not shared pay details for this role.
What employment applies to this position at Amerihealth Caritas Health Plan?
Amerihealth Caritas Health Plan lists this role as a Full-time position.
What experience level is required for this role at Amerihealth Caritas Health Plan?
Amerihealth Caritas Health Plan is looking for a candidate with "Senior-level" experience level.
Does Amerihealth Caritas Health Plan allow remote work for this role?
Yes, this position at Amerihealth Caritas Health Plan supports remote work, giving candidates the flexibility to work outside the primary office location.
What benefits are offered by Amerihealth Caritas Health Plan for this role?
Amerihealth Caritas Health Plan offers Career Development for this position. Actual benefits may vary depending on the employer's policies and employment terms.
What is the process to apply for this position at Amerihealth Caritas Health Plan?
You can apply for this role at Amerihealth Caritas Health Plan either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.