Provider Performance Specialist II
Core
Provide consultative support to healthcare providers to improve their performance on member outreach, utilization management, cost, quality, and risk.
Role type
Field-based provider performance specialist
Builds
Provider performance improvement strategies and data-driven insights
Domain
Managed healthcare / Provider reimbursement
Deliverable
dashboards & analysis
Required skills
Performance data interpretation, presentation development, provider discussion facilitation, value-based performance (VBP) education, report creation
Preferred skills
Claims processing, managed care, clinical licensure (LPN/RN)
Technologies
Corporate reporting tools
Responsibilities
Interpret performance data and prioritize insights, Facilitate provider discussions on quality/utilization/cost/risk, Collaborate with health plan quality counterparts, Develop proficiency in VBP tools and educate providers, Present HBR analysis and create reports for Joint Operating Committee meetings
