Provider Engagement, Clinical Executive

Employment Type: Full time

Position Overview

Become a part of our caring community and help us put health first. The Provider Engagement, Clinical Executive develops and grows positive, long-term relationships with physicians, providers, and healthcare systems. This role supports quality performance and improves member outcomes within the contracted working relationship with the health plan. The Provider Engagement, Clinical Executive works on problems of diverse scope and complexity, ranging from moderate to substantial.

This role represents the scope of health plan/provider relationships across various areas, including:

• Incentive programs
• Quality and clinical management
• Population health
• Data sharing
• Connectivity
• Documentation and coding
• HEDIS and STARs performance
• Other areas related to provider performance, member experience, market growth, and operational excellence.

This work focuses on areas of clinical emphasis. The role advises executives to develop functional strategies (often segment specific) on matters of significance. It exercises independent judgment and decision-making on complex issues regarding job duties and related tasks, working under minimal supervision. The role uses independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities

Collaborate with the market provider engagement/contracting/network optimization/practice transformation team to:

• Develop provider engagement strategy, including VBP, high-volume FFS, and dual-eligible when applicable.
• Participate in meetings with providers and network teams (JOC, Clinical/Quality, Operation).
• Develop and/or standardize QI/clinical provider meeting presentations and reporting packages.
• Create market provider quality/clinical performance profiling and develop strategies to assist low-performing providers in meeting clinical targets.
• Develop EMR interoperability strategy.
• Oversee, plan, and implement provider-facing QI initiatives, including scorecard development/monitoring, gaps in care reports, and CAHPS survey results/strategy.
• Serve as a key contributor to the development and oversight of the care coordination function (CCF) and outcome reporting.
• Serve as a key contributor to market planning sessions on provider risk readiness evaluation and timing.
• Serve as a key contributor to quality strategy for all provider-facing activities, including participating in integrated care internal workgroups.
• Serve as a key contributor to market value-based provider incentive programs, including PCP, specialist, and hospital.
• Act as the DMAS point of contact for workgroups to develop provider strategies to improve member outcomes and close gaps.
• Liaise with providers to assist in developing strategies to improve clinical outcomes, including but not limited to ER utilization, follow-up after hospitalizations, and preventive screenings.

Use your skills to make an impact.

Requirements

• Bachelor’s Degree in a health-related field.
• 5 or more years in clinical strategy and implementation, focused on provider outcomes.
• Experience in healthcare, payor clinical programs, and value-based care organizations.
• Intermediate to advanced experience working with Microsoft Office Products and reporting systems.
• Direct experience working with providers.
• Demonstrated capability to facilitate alignment among cross-functional teams.
• Demonstrated business and financial acumen.
• Must reside in Virginia and be willing to travel to Provider offices and Market office as needed to attend meetings.

Preferred Qualifications

• Registered Nurse.
• 5 or more years' experience in clinical practice working with or within a provider organization.
• Knowledge of an integrated care delivery system.
• Experience implementing Quality Improvement initiatives and strategies.
• Experience using healthcare data and analytics to inform program development.

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office empl...