Provider Performance Manager (Star+Plus)

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Job Summary;

The Provider Performance Manager PPM at Community Health Choice serves as the lead in establishing and supporting a collaborative, innovation-focused relationship with participating practice groups. The primary goal of this role is to optimize practice performance in a value based and/or risk-based environment and assess it against industry standards. The PPM will collaborate internally with various departments, including Credentialling, Medical Affairs, and Technology Platform. Externally, they will work with payer representatives and community partners.

JOB SPECIFICATIONS AND CORE COMPETENCIES

• Lead and manage provider group practices
• Maximize Population Health Outcomes and Provider Satisfaction
• Drive Practice Improvement and Transformation
• Relationship Building and Collaboration
• Data Analysis and Reporting

Reports to Position Title: Director, Provider Performance

QUALIFICATIONS:

Required
Education/Specialized Training/Licensure:Bachelor's degree in business, healthcare administration, or a related field of study;
Or
7 years’ experience in lieu of degree (Must be the equivalent combination of required education and minimum experience.
Work Experience - Years and Area- : Minimum of 3 years of experience in the healthcare industry, preferably with healthcare network operations
and/or practice management with degree.
Minimum of 7 years of experience in the healthcare industry, preferably with healthcare network operations and/or practice management without Bachelor’s degree.
Software Proficiencies: Proficiency with Microsoft Office applications and web-based technologies

Other:

• Demonstrated understanding of risk and value-based contracting.
• Strong provider relations skills and experience.
• Familiarity with payment alternatives such as fee for service, capitation, global budget, performance compensation and episode of care payment.
• Knowledge of patient and practice risk adjustment mechanics and premium-based payment methodologies.
• Demonstrated ability to gain acceptance and compliance from providers and staff to achieve a mutually beneficial outcome.
• Excellent problem solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
• Ability to convey complex or technical information in a manner that others can understand, and ability to understand and interpret complex information from others.
• Successful record of managing multiple projects with demonstrated ability to work independently in rapidly changing environments.