This position operationalizes provider performance and profiling activities by leveraging data and metrics to systematically identify key providers for intervention. Coordinates intervention activities cross departmentally to ensure a streamlined, consistent, and supportive provider experience. Oversees and supports internal teams in the education and interpretation of provider dashboard data and profiling activities. Enhances relationships with large provider and hospital networks through consistent relationship building, communication and data driven discussions. This role also collaborates in a matrixed environment within the CMC to support effective provider performance management in accordance with industry leading practices, client contracts, accreditation bodies and Magellan's goal of the delivery on the Quadruple Aim to enhance member experience, improve population health, reduces costs and improve the work life of healthcare providers, including clinicians and staff.
Responsible for enhancing relationships with key providers leveraging performance and quality metrics to meet the Delivery System and Transformation Department's goals and strategic initiatives.
Understands and reviews operational data, quality outcomes and performance tracking used to support the strategic vision of Delivery System Transformation in collaboration with network, Quality, Clinical, Operations county leads.
Evaluates and provides guidance on impact-ability of provider performance and processes and possible enhancements/modifications.
Monitors, tracks, and identifies trends in provider performance metrics to support need to adjust processes, procedures, and policies to improve operational and clinical outcomes.
Works with network county leads to use operational data and analytics to proactively identify provider operational issues.
Identifies areas of continuous operational performance improvement across the key providers and support the CMC respective leads in implementing improvements.
Oversees training & coaching of network staff on processes, protocols of tracking and interpreting providers KPIs and targets.
Builds network team member expertise through direct feedback and real-time coaching, providing procedural and interpretational assistance.
Collaborates with Account Executives, Quality, Medical and Clinical and Customers on long-term implementation projects to help understand impact to provider performance measurements and tracking metrics; implement changes to data collection or propose appropriate changes to technology or workflows to best collect and synthesize appropriate data.
Works with CMC leadership to ensure staff performance standards are being met.
Supports budget and provider network rate process by providing overview of provider performance metrics, highlighting any variance in performance.
Other Job Requirements
Responsibilities
Bachelor's required, preferably in healthcare, behavioral health.7+ years relevant experience in Managed Care.Ability to lead cross-functional teams and foster partnership across business units.Strong analytical and problem solving skills; ability to drive results and deliver on multiple tasks.Proven expertise in Analytics software or similar business intelligence tools. MS Suite power user; Expert level knowledge of SQL, Qlikview, Tableau or similar business intelligence tools.
General Job Information
Title
Provider Performance and Partnership Consultant
Grade
28
Work Experience - Required
Analytics, Healthcare, Managed Healthcare
Work Experience - Preferred
Education - Required
Bachelors - Behavioral Health, Bachelors - Business Administration, Bachelors - Healthcare
Education - Preferred
Masters - Behavioral Health, Masters - Business Administration, Masters - Healthcare
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
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