Senior Specialist for Provider Network Management

This position is a fully remote position.

Job Summary

Drive provider network strategies and solutions to improve outcomes and decrease medical expense trends. Develop and implement network engagement strategies linking strategic goals to the execution and renewal of alternative payment model contracts through medical expense and utilization oversight of trend variance. Advance the requirements of business and quality improvement plans for assigned Accountable Care Networks and large practice groups.

Essential Functions

• Responsible for contributing to the development and execution of provider strategy and solutions for assigned Accountable Care Networks. Substantially responsible for the execution of the strategy including implementation of an annual strategic plan; coordinating and managing overall activities and developing strategies and approaches to help providers maximize performance potential.

• Drive quality performance through identifying opportunities gaps in care supplemental data submission and best practice sharing.

• Assist in issue resolution when provider network problems are escalated.

• Facilitate joint operating committees with strategic partners and leaders.

• Review and explain alternative payment model performance relative to target.

• Provide relationship management and accountable care network oversight to support success in value based contracts.

• Actively contribute to the interdisciplinary teams to ensure successful engagement of all parties.

• Lead the execution and implementation of payment programs aligning economics with the business strategy to achieve lower per capita cost.

• Manage and implement programs to drive down total cost of care through utilization and medical expense trend oversight

• Identify risk readiness for accountable care networks

• Manage contract success through analysis of monthly reports.

• Provide mitigation solutions for gap closure and quality metric success.

Qualifications

Required

• Bachelors Degree in health care administration business administration accounting finance clinical or health and human services or equivalent education and experience

• 5 years of relevant experience of either provider network management experience health care insurance or other health care delivery setting

Preferred

• Masters degree in health care administration or business administration or other relevant degree

• 2 years of relevant experience directly interacting in a clinical environment

• Proven experience analyzing and assimilating financial and outcomes data

• Knowledge of Patient Profiles and RPX reporting and or other reporting programs

• Experience delivering presentations to a variety of audiences

• Intermediate level knowledge of Microsoft Office Suite

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our topnotch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• Ondemand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location