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Provider Network Remote Jobs in Michigan (NOW HIRING)

Nityo Infotech

Network Cloud Engineer

Ann Arbor, MI · Remote

Remote- Michigan Duration: Long Term This role will provide design and architecture for the network infrastructure and services (InterConnect, Bastion Services, VPC Peering, etc.) for GCP cloud ...

Nityo Infotech

Network Cloud Engineer

Ann Arbor, MI · On-site +1

Remote- Michigan Duration: Long Term • This role will provide design and architecture for the network infrastructure and services (InterConnect, Bastion Services, VPC Peering, etc.) for GCP cloud ...

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Provider Network Remote information

What is the difference between Provider Network Remote vs Provider Relations Specialist?

AspectProvider Network RemoteProvider Relations Specialist
CredentialsTypically requires healthcare or insurance certificationsSimilar certifications, often including healthcare administration
Work EnvironmentRemote, independent work with healthcare providersOffice or remote, focusing on communication with providers
Industry UsageUsed in health insurance and managed care organizationsCommon in insurance companies and healthcare networks
Search & Comparison IntentUnderstanding remote provider network rolesLearning about provider relations and communication roles

Provider Network Remote and Provider Relations Specialist roles share similar credentials and industry settings, but differ mainly in focus. Provider Network Remote emphasizes managing provider networks remotely, while Provider Relations Specialists focus on building relationships and communication with providers, often in an office setting.

What are the most commonly searched types of Provider Network jobs in Michigan? The most popular types of Provider Network jobs in Michigan are:
What are popular job titles related to Provider Network Remote jobs in Michigan? For Provider Network Remote jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Provider Network Remote jobs in Michigan look for? The top searched job categories for Provider Network Remote jobs in Michigan are:
What cities in Michigan are hiring for Provider Network Remote jobs? Cities in Michigan with the most Provider Network Remote job openings:
Provider Network Remote jobs near you
Provider Practice Performance Advisor

Provider Practice Performance Advisor

Amerihealth Caritas

Southfield, MI • On-site, Remote

Full-time

Posted 16 days ago

AmeriHealth Caritas rating

8.3

Company rating: 8.3 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

108th of 281 rated insurance

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

What AmeriHealth Caritas employees say

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