• Manager Provider Performance

    AmeriHealth Caritas Newtown Square, PA 19073

    Job #2314103874

  • Manager Provider Performance

    Location: Newtown Square, PA

    Primary Job Function: Medical Management

    ID**: 25190

    Your career starts now. We're looking for the next generation of health care leaders.

    At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

    Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at ~~~ .

    Responsibilities:

    Manages the development, maintenance and settlement of provider incentive models throughout the AmeriHealth Caritas Family of Companies. Manages and leads a team in performing quantitative and qualitative analyses of utilization and cost data, establishes metrics to measure provider performance, and reports on business and statistical findings and recommendations. Interprets and analyzes data from various sources to develop new metrics to stratify provider performance. Identify potential opportunities in areas such as medical cost improvements, program modifications, and alternative pricing strategies.

    Principal Accountabilities:

    • Works closely with business partners to develop and monitor appropriate valuation methodologies for medical and/or network management programs and initiatives.

    • Supports the development and implementation of strategic business programs and products through effective extraction, analysis, and summarization of appropriate data sets and benchmarks.

    • Leads a team of Analysts to provide strong analytics in support of business and strategic goals and initiatives.

    • Ensures a high level of quality in the analytics and data sets produced by the team.

    • Participates on cross-functional corporate business teams in the development of medical economics programs, metrics, targets, and results as they relate to specific corporate initiatives and programs.

    • Conducts outcomes research and documents findings to measure the extent to which business solutions improve patient well-being, financial performance, and the achievement of corporate goals.

    • Produces comprehensive and valid reports and results to allow for more effective management and growth of the business.

    • Proactively supports efforts to optimize the accuracy, timeliness and completeness of data resources.

    • Utilizes explanatory/predictive models in the development, support and analysis of business initiatives.

    • Maintains an awareness of the evolving healthcare industry and translates knowledge into business opportunities.

    Education/Experience:

    • Bachelor's Degree in relevant field required. MS degree in health policy, health services research, healthcare economics or related field preferred.

    • Minimum 7 years of data analysis and reporting.

    • Minimum 5 years' experience in the healthcare industry with specific focus on value based programs.

    • Extensive knowledge of Microsoft office products is required.

    • Proficiency in SAS enterprise guides a plus.

    EOE Minorities/Females/Protected Veterans/Disabled