Provider Group Manager at Tufts Health Plan in Rocky Hill, Connecticut

Job Description:

We enjoy the important work we do every day on behalf of our members.

Job Summary

The Provider Group Manager (PGM) manages a portfolio of Connecticut-based provider groups participating in value-based care arrangements with CarePartners (CPCT). He/she will be responsible for the development and oversight of provider performance and engagement plans in collaboration with the provider group, CPCT and Tufts Health Plan (THP) staff from various departments. The PGM will support the President of CarePartners and other CPCT medical leadership in understanding drivers of provider performance, development of provider performance engagement strategies. He/she plays a critical role in relationship working with strategic CPCT provider partners to drive performance improvement and the achievement of performance goals. The PGM will analyze information from various sources to understand performance opportunities among provider groups. The PGM will work collaboratively with internal stakeholders and external provider group leadership in all facets of their work and will interact with stakeholders at all levels.

Job Description

Provider Group Performance Planning and Management

• Develop, and manage strategic provider group plans for assigned groups to meet goals for quality, financial performance including risk adjustment revenue and medical cost and utilization, and membership growth. In collaboration with internal leaders and the provider group, facilitate and coordinate the development of performance targets, priorities and action plans.


• Oversee and monitor the execution of performance plans to ensure that initiatives are executed effectively and in a timely manner Ensure accountability for execution of the plan, identify barriers and work with functional owners to develop mitigation strategies.Develop and propose recommendations for performance improvement in conjunction with internal and external subject matter experts.


• Develop a deep understanding of each provider group's performance using various analytic tools (i.e tableau, excel, and other reporting).Perform in-depth quantitative analysis using reports, interactive reporting tools, and self-driven analysis of claims data to identify performance opportunities. Identify, facilitate and coordinate needed analytics to understand performance drivers. Routinely monitor performance against targets.Gather and synthesize contract and performance information from various sources to develop cohesive message.

Provider Group Relationship Development and Management

• Understand the local (Connecticut) provider landscape. Build and maintain strong relationships with key provider group stakeholders/leaders and CPCT functional leaders. Interface frequently with provider group leadership.


• Develop and leverage a keen understanding of assigned provider groups including people, culture, systems, capabilities, performance, challenges and barriers to success.Utilize this understanding to facilitate development of strategies and plans to positively influence performance and the relationship with THP.


• Position CPCT effectively with provider groups.Leverage THP value-added services to drive performance and strengthen the relationship.

Coordination, Planning and Communication

• Serve as coordinator and facilitator between THP and provider group to support performance and relationship management.Coordinate across functions to manage provider group planning, performance and provider group interactions. Coordinate and / manage performance improvement initiatives, as needed.


• Coordinate, prepare and facilitate provider group meetings in coordination with risk adjustment, clinical, sales and contracting business stakeholders. Identify, elevate and drive important issues, initiatives and discussions.


• Develop and lead presentations that provide actionable insights into emerging trends.


• Develop and maintain community of practice to share pertinent information among internal stakeholders


• Serve as an analytic expert and resource for the team

Requirements

EDUCATION:

• Bachelor's degree.Master's or (MPH, MHA, MBA) highly desired

EXPERIENCE:

• 7-10 years of managed care or provider group management experience


• Consulting experience highly desirable

SKILL REQUIREMENTS:

• Demonstrated ability to develop successful relationships both internally and externally.


• Possesses initiative and curiosity, an ability to work independently in a self-directed manner through obstacles and challenges


• Execution focused with ability to prioritize, organize and ensure follow through.


• Strong facilitation skills; ability to work effectively across functions and with people at all levels including clinicians


• Strong analytical skills are required, prior work experience with healthcare data including medical, pharmacy, and behavioral health data. Strong working understanding of administrative language of healthcare (e.g. ICD, CPT, and J-codes), competence in advanced Excel functions, and ability to draw insights from data


• Critical thinking skills; ability to aggregate and synthesize data to draw meaningful insights and develop cohesive message


• Excellent communication skills, both oral and written


• Ability to drive results using influence.


• Effective problem solver


• Familiarity with Medicare Advantage and Medicaid programs preferred

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:

• May include local / regional travel


• CT resident preferred

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

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