Manager, Network Management

US-IL-Chicago
Req No.
2017-1761
Category
Operations
Type
Regular Full-Time

Overview

ConcertoHealth Inc. has more than a decade of experience caring for the Medicare, Medicaid, frail and complex medical needs patient populations. The company addresses critical vulnerabilities for patients and health plans alike: expanded access to personalized primary care, chronic condition management and coordination of transitions between care settings.

Through its ConcertoHealth Care Centers, the company provides healthcare services where and when they’re needed, delivering primary care and care coordination regardless the location – be it clinic, home, hospital or post-acute settings.

 

Working under the direction of the Vice President of Business Performance, the Manager of Network Management will lead the team of Network Management representatives to drive improvements in Healthcare Quality, Performance and Cost Reduction in our Health Plan Partner’s Provider Networks through enhanced collaboration, data sharing, root-cause analysis and problem solving.

 

The Manager of Network Management will establish and provide oversight to the Network Management Representatives while simultaneously managing provider and system relationships within their assigned region and providing best-in-class customer service and support.

Responsibilities

  • Assist in the establishment and refinement of a best-in-class Network Management program
  • Develop, maintain and operationalize performance reporting metrics for Network Management Representatives
  • Lead a team of Network Management Representatives to achieve Quality, Outcome and Documentation Accuracy goals
  • Develop and implement provider engagement strategies aimed at improving Quality and Outcomes
  • Lead detailed analyses of Network Performance to further optimize provider and network engagement opportunities
  • Provide information and coaching on value based care; articulate the value proposition to providers
  • Increase provider engagement on managing quality and efficiency (cost/utilization) for patients in their practice
  • Manage provider performance through education on quality measures (HEDIS, HOS, CAHPS), risk adjustment, and the associated tools available
  • Influence provider behavior to improve quality using Concerto data, tools and the associated analytics
  • Educate providers on the quality incentives available to drive quality and efficiency within their practice, while improving outcomes for patients
  • Deliver continuous feedback to providers and health systems (i.e., PHOs) leveraging performance dashboards, face-to-face meetings and telephonic outreach
  • “Close” visits with actionable agreement of participation, document next steps and have exceptional follow-up to ensure results
  • Contract with and/or manage providers across the delivery system (physicians, skilled nursing facilities, hospitals, HCBS providers) in instances where Concerto may have an incentive to do so under a value based contract

Qualifications

  • Bachelors Degree; and Masters Public Health is a plus
  • Experience managing teams with goal-oriented performance requirements
  • Experience leveraging analytical insights to develop strategies and problem solve
  • Experience with Government programs (Medicaid, Medicare and the dual demonstration program)
  • Experience with Michigan market, and knowledge of existing provider delivery systems and referral patterns
  • Knowledge of the medical, behavioral health and home and community based services components of the network
  • Ability to think through and execute on a “tiering” of the network based on quality driven measures

 

Competencies:

 

  • Team leadership and management skills
  • Strong interpersonal skills, and experience working with providers (especially PCPs) and their practices in face-to-face settings
  • Ability to analyze performance metrics, make recommendations and collaborate on ways to improve provider performance
  • Demonstrated track record of implementing and executing on provider based initiatives, including quality, outcome and cost-management initiatives
  • Exceptional organizational skills and ability to manage a diverse network of providers, relationships and initiatives
  • Ability to work with clinical and operational teams to achieve success across multi-disciplinary initiatives

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