Director, VBR & Risk Adjustment

Job Summary

The Director, Network Performance & Engagement provides expert leadership, analysis and ongoing support in the areas of provider network operations including Total Cost of Care (TCOC), value-based purchasing, and state or federal quality initiatives, business issue identification and analysis, business process redesign, application of best practice methodologies, and identification of strategic and financial opportunities / risks.

Essential Functions

* Oversee and monitor physician and standard health partner contracting and on-going relationships with the plan’s physician and health partner network and ensures provider satisfaction is met * Provide assistance in both the analysis and implementation of initiatives focused on improving quality outcomes and risk adjustment scoring * Oversee and monitor network access standards for market to include recruitment for network gaps and/or new product development * Develop regional business plan based on the market business plan that will expand the service area, build the enrollment of the plan, and improve quality outcomes for the network * Represent CareSource to local market through community engagement and board memberships and play an active role in the local trade and professional organizations * Monitor the financial activities of the plan including budgeting and forecasting to ensure financial goals are met * Maintain a strong and cooperative working relationship with provider agencies and regulatory agencies * Collaborate as a change leader in translating issues, goals and objectives into practical and integrated solutions and services that help to ensure optimum business performance * Oversee the development and application of policies, standards, benchmarks, metrics and quality controls * Work in conjunction with staff, consultants, management and administration to design project plans, conduct studies, make recommendations and develop implementation plans for operations