Provider Performance Consultant

Richmond VA 23233

Job Description

Builds positive relationships between Magellan Complete Care (MCC) and its high-volume providers to facilitate high quality care for members. The consultant achieves this goal through analyzing and sharing provider performance metrics related to quality, clinical outcomes, coding and utilization used to support MCC programs. Consultants will be the primary liaison between MCC providers and an internal, cross-functional team of quality, clinical, analytics, provider relations and medical personnel. The Consultant will work both internally and externally with 75% of time in the field at provider offices.

Essential Functions

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  • Builds and maintains strong professional relationships internally and with leaders and staff of provider organizations 
  • Assesses current practice patterns, assets and challenges utilizing NCQA, HEDIS, Medicare STARS, state and regulatory standards 
  • Assesses configuration and provider’s current use of IT tools that support population health and care management (EMR, billing and scheduling software, population health tools, etc.) and suggests potential enhancements to configuration, workflows and/or processes 
  • Uses advanced communication, presentation and facilitation skills to communicate the strategy and achieve the objectives for the provider group 
  • Establishes a project plan with the practice that identifies goals and objectives for improvement 
  • Tracks progress towards monthly goals and objectives and develops solutions and action plans to improve progress 
  • Assesses and recommends new initiatives to assist providers in reaching their quality goals, including but not limited to enhanced usage of IT tools and various provider education trainings 
  • Explores opportunities for improved, bi-directional information exchange between providers and MCC 
  • Leads and facilitates workgroups, both internally and externally, to manage programs and measure key performance metrics 
  • Designs, implements and executes internal and external training sessions on quality and coding topics 
  • Develops and tracks progress of opportunities for member experience improvement to positively impact CAHPS (Consumer Assessment of Healthcare Providers and Systems) scores 
  • Improves the understanding and sensitivity to the unique needs of Magellan Complete Care’s population and caregivers 
  • Collaborates across multi-departments for member and provider outreach activities 
  • Performs other duties and projects as assigned 

General Job Information

Title

Provider Performance Consultant

Grade

23

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

5/22/2019

Date Requisition Created

5/15/2019

Minimum Qualifications

Education

Bachelors: Healthcare (Required)

License and Certifications - Required

License and Certifications - Preferred

CPC - Certified Professional Coder - Enterprise, LPN - Licensed Practical Nurse - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Other Job Requirements

Responsibilities

Required Qualifications

  • Bachelor’s degree in healthcare or related discipline or four years of equivalent relevant work experience 
  • Five years of experience in practice management or an administrative leadership role in a primary care setting 
  • Knowledge of financial metrics, ICD-10 coding, Medicaid risk adjustment methodology (CDPS Rx), Medicare STARS, HEDIS and common billing practices 
  • Proficient in Microsoft Office tools 
  • Strong analytical skills and strategic thinking 
  • Strong communication skills, both verbally and written 
  • An ability to travel frequently across the assigned territory for in-person provider support 
  • Demonstrated experience in leading significant cross-functional work 
  • Ability to interact effectively with Business owners, senior management, and peers across the organization

Preferred Qualifications

  • RN or LPN 
  • Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Risk Adjustment (CRC) Coder, or Certified Professional Coder (CPC) or Certified Medical Audit Specialist (CMAS) 
  • Ability to manage relationships with an emphasis on internal and external mid-level relationships 
  • Ability to work across all levels of the organization, including working with executive audiences, vendors and the government as a customer 
  • Demonstrated ability to select and implement strategies that are most likely to be successful 

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”