Manager Provider Performance Improvement (Hybrid/Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
This position will require at least 3 days in person at the HAP building in Troy and/or at provider locations.
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.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System 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.