The Director, Provider Performance Engagement is responsible for shaping and implementing strategies that enhance the quality of care of our members, while leading transformational change in the market. This role involves working effectively with all levels of the organization, individuals, and teams across all disciplines to ensure compliance and improve provider performance.
Essential Functions:
- Lead the implementation of Alternative Payment Model (APM) agreements, ensuring that provider performance and engagement are functional and compliant with CareSource provider agreements, ODM, and CMS requirements.
- Lead the development and execution of CareSource's Behavioral Health strategy, focusing on improving access and quality of care for members.
- Coordinate efforts to assess provider APM level and readiness, analyze gaps in care, and work with regional teams to advance providers along the care coordination continuum.
- Contribute to the development of APM quality and performance programs to ensure alignment with Quality, Contracting, and Network Performance, providing standardization among provider entities.
- Oversee day-to-day operations for behavioral health provider performance and relations, ensuring compliance with all state and business operational, clinical, and program requirements.
- Participate in and lead All-Plan activities tied to quality withhold and other regulatory body programs and initiatives.
- Partner with the Provider Network Performance team to ensure quality, performance metrics, and financial performance meet contract specifications for all providers.
- Lead the development and maintenance of departmental policies and procedures.
- Design and implement strategies to increase provider engagement, driving better quality, member satisfaction, improved population health, and reduced healthcare costs.
- Perform any other job related duties as requested.
Education and Experience:
- Bachelor's in nursing, business, health administration, health policy or related discipline required
- Master's of business administration (MBA), Health Administration (MHA), Health Policy or related field preferred
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Five (5) years of experience clinical experience in healthcare delivery and oversight is required. required
- Five (5) years of leadership/management experience required
- Five (5) years of experience in case management and/or population health preferred
- Experience in managing provider compliance and contracting preferred
- Experience speaking before individuals and groups, vendors, and executive leadership preferred
- Comprehensive knowledge of APMs, behavioral health, case management, medical management, and quality improvement.
- Strong organizational, analytical, and problem-solving skills.
- Exceptional oral and written communication skills, with the ability to engage effectively with diverse audiences.
- Proven leadership capabilities with a focus on collaboration and relationship building.
- Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel
- Proficient with other technologies such as smartphone or other mobile communication devices
- Knowledge of and application of regulatory standards and measures including but not limited to State Medicaid Programs, Medicare, and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.), quality improvement and HEDIS programs/outcomes measurement
- Knowledge of provider contracting and familiarity with provider operations
- Excellent leadership skills, with ability to effectively manage a high performing team, and provide coaching and development
- Excellent oral, written, and interpersonal communications skills to effectively interact, exercise discretion, judgement and diplomacy when dealing with internal and external customers
- Ability to interact with all levels of leadership, and lead cross-functional teams and initiatives
- Ability to recognize opportunities for improvement, handle complex responsibilities, and lead change
- Highly motivated individual with the ability to adjust to shift priorities, multi-task, work under pressure and meet deadlines
- Current, unrestricted license as a Registered Nurse (RN), LPN, Social Worker, or other clinical discipline in state of practice required
- Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
- General office environment; may be required to sit or stand for extended periods of time
- Ability to travel as required by the needs of the department.
Compensation Range:
$113,000.00 - $197,700.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
Brand=CareSource
Skills Required
- Bachelor's degree in nursing, business, health administration, health policy, or a related discipline
- Equivalent relevant work experience may substitute for required education
- Five years of clinical experience in healthcare delivery and oversight
- Five years of leadership or management experience
- Five years of experience in case management and/or population health
- Experience managing provider compliance and contracting
- Experience speaking before individuals, groups, vendors, and executive leadership
- Current, unrestricted license as a Registered Nurse, LPN, Social Worker, or other clinical discipline in the state of practice
- Valid driver's license, vehicle, and verifiable insurance
- Successful driver's license record check
- Annual influenza vaccination during the required influenza season
- Knowledge of alternative payment models, behavioral health, case management, medical management, and quality improvement
- Knowledge of state Medicaid programs, Medicare, ODM, CMS, NCQA, URAC, HEDIS, and quality accreditation standards
- Ability to travel as required by departmental needs
CareSource Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CareSource and has not been reviewed or approved by CareSource.
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Strong & Reliable Incentives — Bonuses are regularly available and serve as a meaningful part of total compensation. Annual performance-based awards are considered a strong component.
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Leave & Time Off Breadth — PTO starts around four weeks and increases with tenure, complemented by paid holidays and a floating day. Volunteer time expands the available leave options.
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Affordable Benefits — Health plan options are considered affordable, supported by wellness incentives that can reduce premiums. Coverage breadth includes medical, dental, vision, and cost‑lowering programs.
CareSource Insights
What We Do
Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve. CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf Si usted o alguien a quien ayuda tienen preguntas sobre CareSource, tiene derecho a recibir esta información y ayuda en su propio idioma sin costo. Para hablar con un intérprete, Por favor, llame al número de Servicios para Afiliados que figura en su tarjeta de identificación. 如果您或者您在帮助的人对 CareSource 存有疑问，您有权 免费获得以您的语言提供的帮助和信息。 如果您需要与一 位翻译交谈，请拨打您的会员 ID 卡上的会员服务电话号码
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