About this role

Develop strategic partnerships between the health plan and contracted provider networks
Engage with providers to align on network performance opportunities and solutions
Drive optimal performance in contract incentive performance, quality, and cost utilization
Participate in the development of network management strategies
Serve as primary contact for providers and act as liaison ensuring coordinated effort in improving performance
Investigate, resolve and communicate provider claim issues and changes
Perform provider orientations and ongoing education
Evaluate provider performance and develop strategic plans for improvement
Present detailed HBR analysis and create reports for Joint Operating Committee meetings

Bachelor’s degree in related field or equivalent experience
Three or more years of managed care or medical group experience, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations
Project management experience at a medical group, IPA, or health plan setting
Strong communication and presentation skills
Proficient in HEDIS/Quality measures, cost and utilization

VBC Performance Manager

Key skills