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Cahps Director Jobs (NOW HIRING)

By the Bay Health

RN Director of Home Health

Larkspur, CA · On-site

$160K - $180K/yr

The RN Director of Home Health directs and manages daily operations of Home Health Services. This ... Works with Quality Assurance on CAHPS scores Education/Experience: * Degree as a registered nurse.

Twin Health

Director, Medicare Advantage Strategy

Bring expertise across key MA domains including member experience, Stars and quality, CAHPS ... direct exposure to MA. * Member & Market Expertise: Deep understanding of the Medicare population ...

IEHP

Senior Director, Contracting

Rancho Cucamonga, CA · On-site

$229K - $265K/yr

The Sr. Director leads complex contract negotiations and ensures all contracting activities align ... but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks * Competitive salary ...

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Dir Network Perform & Engagemt

Southfield, MI • On-site

AmeriHealth Caritas Health Plan
Health Care and Social Assistance • 5 - 10K employees
Learn more about AmeriHealth Caritas Health Planexternal

Full-time

Re-posted 3 days ago

AmeriHealth Caritas rating

8.3

Company rating: 8.3 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

Job description

Role Overview: The Director, Provider Network Performance & Engagement is responsible for leading strategies and initiatives to optimize provider network performance, advance value-based contracting, and strengthen provider relationships.
Work Arrangements:
  • Hybrid - Associate must reside in Michigan (MI) and work onsite at the Southfield, MI office two days per week.

Responsibilities:
  • Lead initiatives to monitor and improve provider performance, focusing on quality, efficiency, cost of care, and patient outcomes.
  • Responsible for development and execution of annual provider network strategy to include network adequacy standards, value-based strategies to drive and improve outcomes and engagement, and strategies to deliver a market-competitive network.
  • Analyze utilization and financial performance data to identify cost drivers and implement targeted interventions.
  • Oversight of VBP negotiations, VBP Contract performance, and leading VBP strategies in collaboration with internal stakeholders.
  • Monitor SCA and out-of-network utilization and trends, and develop contracting strategies to improve and increase in-network utilization.
  • Responsible for departmental staffing decisions and provides supervision to assigned staff, writing and performing annual reviews, and monitors performance issues as they arise.
  • Ensures department staff remain compliant in all aspects of Federal and State rules, regulations, policies, and procedures, and creates or modifies departmental policies to reflect changes.
  • Establish key performance indicators (KPIs) and regularly report on network performance to executive leadership.
  • Actively partners with the Market Director of Quality to drive Company-wide and Plan quality initiatives, such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance/Utilization Review Accreditation Commission (NCQA/URAC), and analytics teams to ensure alignment on performance strategies.
  • Responsible for oversight of network adequacy monitoring and managing provider network, developing strategies to close gaps, and ensuring appropriate access to services throughout the Plan's territory.
  • Oversight of large-scale provider terminations to include tracking, reporting, and identifying risks and strategies for gap closure and access.
  • Ensures provider contracts are consistent with organizational guidelines, claim payment methodologies, and state and federal regulatory requirements.
  • Ensures that non-standard contract elements are tracked and communicated to appropriate departments and obtains AHC and Plan approval before submission to the provider.
  • Responsible for leading complex negotiations for facilities and value-based contracts for clinically integrated networks.
  • Other duties as assigned.

Education & Experience:
  • Bachelor's degree required.
  • 5 or more years of provider contracting experience with various reimbursement models.
  • 10 or more years of healthcare strategy, provider relations, or network management.
  • Managed care experience preferred

Skills & Abilities:
  • Strong knowledge of provider network management, provider contracting, and reimbursement methodologies.
  • Demonstrated experience developing and executing provider network strategies that support quality, cost, access, and performance goals.
  • Ability to lead value-based payment strategies, risk-sharing arrangements, and complex provider negotiations.
  • Strong analytical skills with the ability to interpret utilization, financial, quality, and network performance data.
  • Knowledge of network adequacy standards, access requirements, and state and federal managed care regulations.
  • Ability to identify cost drivers, performance gaps, and provider access issues and develop targeted improvement strategies.
  • Strong understanding of HEDIS, CAHPS, NCQA, and URAC quality standards.
  • Excellent leadership and people management skills, including staff supervision, performance management, and departmental planning.
  • Strong relationship-building skills with providers, executive leadership, internal departments, and external stakeholders.
  • Excellent written and verbal communication skills, including the ability to present complex information to executive audiences.
  • Ability to collaborate cross-functionally with quality, analytics, finance, operations, and compliance teams.
  • Strong problem-solving, decision-making, and strategic planning skills in a fast-paced managed care environment.

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