Manager, LTSS Provider Network Performance

» Manager, LTSS Provider Network Performance
Healthcare
in Clayton
, MO
Reference: 19-03377

Position Purpose:

  • Develop, manage and support high performing provider network performance for Medicaid Long Term Services and Supports (LTSS) including metrics, improvements, including analytics, reporting, training and education
  • Leverage various tools and solutions to support effective provider engagement activities
  • Collaborate with health plan leaders and LTSS product leaders to review LTSS network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop improvement plans
  • Determine analytic reporting needs and provide training and support on network performance applications and reporting tools
  • Lead provider profiling and network performance analytic support functions and provide support to health plans and other stakeholders
  • Monitor and measure provider Health Benefits Ratio (HBR), quality, unit cost and utilization trends and identify and implement network improvement opportunities
  • Support existing application tools and solutions, identify and recommend technical enhancements to improve outcomes and functionality

Education/Experience:

  • Bachelor’s degree in Business, Economics, Finance, Healthcare or related field or equivalent experience
  • 4+ years of contracting, health care reimbursement, provider contract modeling or quality measurement experience
  • Prior experience building and managing relationships with health care providers preferred