Government Programs Provider Performance Director
Cambia Health Solutions

Seattle, Washington

Posted in Health and Safety


This job has expired.

Job Info


Government Programs Provider Performance Director

Oregon, Washington, Idaho or Utah

The Government Programs Provider Performance Director develops provider engagement strategies to drive performance improvements and quality initiatives related to Stars, Risk Adjustment and other Medicare initiatives. They develop performance metrics, provides analysis and recommendations for improved outcomes. In conjunction with regional network strategies, they build provider relationships to deploy interventions with the goal of driving innovation and sustainable improvements in quality.

Additionally, they develop strategies and manage initiatives, projects and work streams, in partnership with cross-functional teams, to drive the transformation of healthcare for Regence Medicare members related to provider engagement, network strategy and clinical quality improvements.

Minimum Requirements

  • Demonstrated knowledge of medical group/IPA operations, integrated delivery systems, and health plans, as well as industry trends, challenges and solutions as they relate to improved performance in Medicare initiatives for Stars and Risk Adjustment.
  • Knowledge of provider coding, documentation practices, reimbursement and contract methodologies
  • Demonstrated acumen identifying problems, developing solutions, and implementing a chosen course of action to resolve issues and build consensus among groups of diverse stakeholders. Ability to develop and drive new initiatives from concept through execution, including developing, managing and leading complex projects.
  • Demonstrated ability to develop relationships quickly and leverage working relationships to drive performance outcomes. Excels at working with all levels of staff, within and external to the organization, to achieve goals.
  • Strong written and verbal communication and facilitation skills, excellent presentation and public speaking skills (formal and informal)
  • Demonstrated analytical and problem-solving ability with the skills to interpret and present complex data to all levels of stakeholders internal and external.
  • Demonstrated proficiency with collaboration tools (Teams), presentation, word processing, CRM, reporting and spreadsheet software used to create and maintain databases, spreadsheets, reports and documents.
  • Successful working independently as well as being a strong team leader and contributor. Identifies and distills multiple inputs into priorities and drives results
  • Ability to work in a high-pressure environment and effectively manage conflict and ambiguity.

Normally to be proficient in the competencies listed above:

The Government Programs Provider Performance Director would have a Bachelor's Degree (Master's Degree preferred) in healthcare, science, business or related field and 12+ years' experience in one of the following areas: Provider strategy development or implementation, Provider contracting and reimbursement, managed care, healthcare delivery, risk adjustment, Stars, or equivalent combination of education and experience.

General Functions and Outcomes
  • Initiates and leads network efforts focused on industry best practices. Acquires deep knowledge of Star metrics to oversee performance of provider controllable measures for all contracted groups. Identifies barriers and offers tailored solutions based on group cultures and competencies. Leads performance discussions with provider groups to create awareness of member gaps in care while overcoming objections to quality improvements to drive change.
  • Contributes to the overall development and execution of cohesive and coordinated network business strategies by working with Network Management leadership, internal teams and subject matter experts to support action plans. Partners with the Network Management team to identify key stakeholders and technologies within provider groups to support key initiatives and strategies.
  • Improves provider organization performance through data analysis, knowledge of best practices, and development and execution of interventions in collaboration with peers and leaders of contracted healthcare delivery systems.
  • Serves as a Subject Matter Expert for the Stars, Risk Adjustment, and other Medicare programs and stays informed and updated on measures, program changes and quality gap closure processes. Uses knowledge to support providers in educational and training opportunities. Establishing credibility as a trusted advisor and resource to influence positive change while imparting a great company image and professional demeanor
  • Develops and deploys best-practice network incentives/recognition. Participates in internal workgroups to support development of effective member and provider network- directed interventions; coordinates interventions with internal stakeholders.
  • Manages and implements the Medicare Quality Incentive Program with assigned provider groups and promotes their focused use of available resources and tools to improve member health outcomes. Monitors progress and creates awareness of course corrections when needed.
  • Monitors supplemental data exchange between provider groups and the company to support the improvement in performance measures for the Stars program.
  • Forensically works with provider groups to identify where technology disconnects may exist to improve data accuracy.
  • Conducts provider trainings for the Quality Incentive Program, provider tools and various supporting programs through face-to-face meetings, workshops and webinars. Identifies provider groups for data accuracy improvement training. Coordinates and supports the Medicare Training Specialist in these efforts.
  • Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
  • Develops strategies to navigate health care delivery systems to increase provider engagement by articulating the value proposition and mutual benefits to improve member health outcomes.
  • Develops and manages execution of communication and messaging strategies in pursuit of objectives and initiatives.
  • Assesses and communicates project status, key business risks and vulnerabilities to leadership. Recommends and implements appropriate action steps and coordinates with internal teams to follow through to close action plans. Develops and oversees monitoring and reporting procedures to ensure deliverables and budget are on track.
  • As a Network Management team member - lead, participate, and contribute to internal committees/workgroups as assigned; act as a mentor to others within the overall team.
  • Creates a sense of urgency within the organization and translates quickly evolving directions into action.
  • Adheres to all quality, compliance and regulatory standards

The base pay annual salary range for this job is $111,000-$192,000 as well as an annual bonus.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

  • medical, dental, and vision coverage for employees and their eligible family members
  • annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  • paid time off and company holidays
  • up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  • up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  • one-time furniture and equipment allowance for employees working from home
  • up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.


This job has expired.

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