Remote Risk Management Jobs in Charleston, SC (NOW HIRING)

Position Summary

The Practice Performance Advisor is part of the POD support model and supports the Provider Network Management (PNM) team and provider network by producing and presenting performance reporting, value-based care (VBC) models, care coordination effectiveness, and practice efficiency insights. This role partners closely with providers and internal stakeholders to identify improvement opportunities and drive measurable gains in quality and performance.

Key Responsibilities

• Collaborate with providers on performance-based programs and measures, including HEDIS, withholds, total cost of care (TCOC) metrics, and other quality/performance initiatives.
• Produce quality and performance reporting, identify opportunities, and develop strategies in preparation for Joint Operating Committee (JOC) and other stakeholder discussions.
• Interpret claims and utilization data to connect trends to patient outcomes and utilization patterns; translate insights into actionable recommendations.
• Partner with Quality, Account Executives, local market network teams, and clinical leaders (e.g., CMO) to align provider outreach and performance improvement plans.
• Meet with providers to review gaps in care, discuss performance data, and develop provider action plans to address opportunities and strengthen partnerships.
• Implement and provide oversight of performance-related projects based on corporate best practices and strategy.
• Use data and analysis tools to identify performance improvement opportunities and collaborate with peers to design interventions that support provider action plans.
• Track action plans and outcomes of initiatives that advance value-based (VB) performance year over year; prepare updates and reporting.
• Support network and quality strategy through cross-functional collaboration with PNO, PNM, and Quality programs to achieve goals and objectives.
• As needed, assist with scheduling member appointments and participate in member outreach meetings in addition to provider meetings.

Required Knowledge & Skills

• Knowledge of value-based contracts and performance programs with providers, including HEDIS, withhold measures, TCOC metrics, and other quality-based programs.
• Strong analytical skills to interpret and present provider performance data; ability to translate data into actionable insights.
• Working knowledge of reimbursement models and methodologies, including risk-based and value-based contracting.
• General operational knowledge related to provider satisfaction, education, and communication, with foundational understanding of claims coding, payment integrity, provider data, credentialing, appeals/disputes, and compliance considerations (State, Federal, and STARS standards).

Qualifications

• Required
  • Three (3) or more years of Account Executive (AE) experience, total cost of care (TCOC) experience, and understanding of reimbursement methodologies, including risk-based or value-based contracting.
  • Experience with quality and provider performance reporting, including HEDIS or other quality measures.
  • Valid driver's license in state of residency.
• Preferred
  • Bachelor's degree in healthcare administration or a related field.
  • If no bachelor's degree, five (5) or more years of relevant experience.

Work Environment & Travel

• Hybrid / Remote role with work performed from home and in the community (provider-facing).
• Requires moving between office and non-office locations; frequent computer and office equipment use.
• Ability to occasionally stand, sit, walk, climb stairs, and communicate effectively in meetings.
• May require lifting/carrying less than 10 pounds.
• Travel may be required up to 60%.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.