Remote Risk Management Jobs in Moncks Corner, SC

Work Arrangement:

This position is a remote field based position. Must reside in South Carolina. Will be required make provider visits throughout the state.

Job Summary

The Performance Practice Advisor, is part of the POD support model and provides support to the Provider Network Management team and Provider Network responsible for producing and presenting performance reports, VBC models, care coordination effectiveness and practice efficiencies.

Work Arrangement: Fully remote must be available to work during Eastern Time Zone

Essential Functions

Collaborates with providers as it relates to HEDIS, withhold measures, TCOC performance metrics and other performance-based programs. Coordinates with the Quality Team on key reports and initiatives related to provider performance. Supports Account Executives and local market provider network team in directing interactions that relate to providers' quality and performance. Responsible and accountable for improving provider's performance.

Responsible for:

• Produce all quality and performance related reporting establishing opportunities and strategies regularly in preparation for JOC's.
• Interpret claims data and connections to patient outcomes and utilization trends.
• Interprets utilization trends, optimizing performance based on state driven quality improvement programs i.e. HEDIS.
• Attends meetings with providers to review gaps in care and developing plan of action with the provider to address these gaps in conjunction with PNM and CMO as applicable.
• Supports network and quality strategy.
• Implements and provides oversight of performance related projects as corporate best practices and strategy have identified.
• Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies of which can be applied to the provider action plans.
• Conducts meetings with providers to review performance data and discuss areas of opportunities to strengthen provider partnerships in conjunction with PNM and CMO as applicable.
• Tracks and prepares reports on action plans and outcomes of initiatives that advance provider VB performance per year.
• Provides cross functional collaboration with PNO, PNM, and Quality program to achieve goals and objectives.
• May assist with scheduling appointments for members and attend member outreach meetings in addition to provider meetings.

Knowledge for:

• Value-based contracts with providers as it relates to HEDIS, withhold measures, TCOC performance metrics and other quality-based programs.
• General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims coding, payment integrity, provider data, credentialing, appeals disputes etc. applicable to State, Federal and STARS standards to ensure compliance.

Education/Experience

• Associate's Degree Required
• Bachelor's degree in healthcare administration or similar field required.
• Five (5) or more years of experience in provider networking if no bachelor's degree.
• Three (3) or more years Account Executive experience, total cost of care, understanding of reimbursement methodologies to include risk or Value Based contracting

• Understand quality and provider performance reporting and HEDIS or other quality measures.

Other Skills

• Healthcare regulations, reimbursement models and quality measures.

• Possesses strong analytical skills to interpret and prepare provider performance data.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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.

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.