Practice Performance Advisor

Practice Performance Advisor Amerihealth Caritas - 3.2 Southfield, MI Job Details Full-time 1 day ago Qualifications Driver's License Bachelor's degree

Full Job Description Role Overview:

The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.

Work Arrangements:

Remote - The associate can be located anywhere in Michigan (MI). 50% travel is required to the provider's location and attend office meetings at our Southfield, MI location.

Responsibilities:

Produce all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for the Joint Operating Committee (JOC). Present information to the provider, colleagues, and the executive team in a clear, concise manager Analyze claims data, utilization trends, and patient outcomes to support performance optimization Support provider engagement related to Healthcare Effectiveness Data and Information Set (HEDIS), Total Cost of Care (TCOC), and other performance-based programs Partner with Quality, Provider Network, and Account Executive teams to align strategies and improve provider performance Participate in provider meetings to review gaps in care and develop action plans in collaboration with Provider Network Management (PNM) and Chief Medical Officer (CMO) teams Lead and support performance improvement initiatives and projects aligned with corporate strategy and best practices Identify opportunities using data and collaborate with internal teams to develop and implement targeted intervention strategies Track, monitor, and report on provider action plans and outcomes to measure the effectiveness of initiatives Support network and quality strategy execution across markets Maintain strong cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality teams to achieve performance goals May assist with member outreach efforts and coordination of care-related activities

Education & Experience:

Bachelor's degree in healthcare administration or related field required 3 years of Account Executive experience or provider engagement experience, demonstrating knowledge of TCOC and Medical Loss Ratio (MLR) analysis, is required. Experience in a variety of provider reimbursement methodologies, including value-based or risk-based contracting Understand quality and provider performance reporting, including HEDIS and other quality measures.

Licensure:

Valid driver's license, transportation, and insurance required:

Skills & Abilities:

Strong understanding of healthcare regulations, reimbursement models, and quality metrics, specifically in HEDIS and STARS Ability to analyze and interpret complex healthcare data and translate insights into actionable strategies Knowledge of provider operations, including claims coding, payment integrity, credentialing, appeals, and disputes Experience working with value-based care programs and performance measures Excellent communication and collaboration skills with the ability to engage providers and cross-functional teams Strong analytical, problem-solving, and reporting capabilities Ability to manage multiple priorities and drive performance improvement initiatives