LTSS Provider Network Performance Manager

Clayton, MO 63105

Post Date: 05/07/2018 Job ID: 27212 Category: Professional

Position Purpose:
  • Develop, manage and support high performing provider network performance for Medicaid Long Term Services and Supports (LTSS) including metrics, improvements, including analytics, reporting, training and education.
  • Leverage various tools and solutions to support effective provider engagement activities.
  • Collaborate with health plan leaders and LTSS product leaders to review LTSS network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop improvement plans.
  • Determine analytic reporting needs and provide training and support on network performance applications and reporting tools.
  • Lead provider profiling and network performance analytic support functions and provide support to health plans and other stakeholders.
  • Monitor and measure provider Health Benefits Ratio (HBR), quality, unit cost and utilization trends and identify and implement network improvement opportunities.
  • Support existing application tools and solutions, identify and recommend technical enhancements to improve outcomes and functionality.

  • Bachelor s degree in Business, Economics, Finance, Healthcare or related field or equivalent experience.
  • 4+ years of contracting, health care reimbursement, provider contract modeling or quality measurement experience.
  • Prior experience building and managing relationships with health care providers preferred.

For more information about this position, please contact us at 877-782-3334.


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