Provider Improvement Analyst

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of Care Source, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises.

CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

The Provider Engagement Specialist— Provider Delegation Performance is responsible for overseeing and improving the performance of delegated partnership programs and act as the engagement lead for high value, strategic health partners.

• Assume full management responsibility for all performance measure components, including end-to-end data collection, evaluation, and timely dissemination of reports to both internal teams and delegated providers.
• Lead for identified Market performance and engagement strategic initiatives under the direct supervision of their manager.
• Market lead for performance and engagement activities to support overall network performance, new products, and product expansion.
• Develop a deep understanding of all program measures and metrics to support delegated providers in interpreting performance data and meeting expectations.
• Collaborate with providers individually to create and monitor performance improvement plans, engaging internal subject matter experts as needed and ensuring accountability for baseline performance standards.
• Knowledgeable of federal and state laws and regulations pertaining to provider contracting.
• Drive quality outcomes through execution and support of Value Based Reimbursement agreements with providers.
• Assume leadership role in JOC’s (Joint Operating Committees) with key health partners and be able to develop and present data on Provider performance.
• Enhance effectiveness of Providers’ population health through a variety of member health outcome and quality improvement techniques.
• Collaborate with Population Health Analytics team in coordinating the exchange of clinical information and member/population level data.
• Assist in development and implementation of strategic plans in collaboration with leadership and population health analytics team.
• Collaborate with the Provider to develop and enhance the practice’s engagement strategies for individual members.
• Generate monthly and quarterly performance and administrative reports, ensuring consistency, accuracy, and timely distribution to delegated providers. This includes reporting related to contracts, regulatory, NCQA and other requirements.
• Provide on-site practice transformation support and education to Providers identified as partners in the Care Source PCMH program. Care Source supports the NCQA Patient Centered Medical Home model.
• Works with leadership and stakeholders to evaluate policy and process changes for potential provider impacts, monitors implementation of key initiatives, and provides leadership on initiatives affecting providers.
• Ensures Care Source complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards, and participates in market audits.
• Perform any other job duties as requested.

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required.
• Master’s Degree is preferred.
• Minimum of five (5) years of healthcare experience, to include three (3) years of direct work experience in provider relations and/or provider contracting.
• Managed care experience is required.
• NCQA PCMH experience is preferred.

• Intermediate proficiency level with Microsoft Outlook, Word, and Excel.
• Experience with Medicaid and Medicare products and programs.
• Value-based program oversight and performance tracking.
• Experience working within FQHCs, Health and Human services providers or equivalent.
• Knowledge…