Senior Manager, Provider

Point
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Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point
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Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are.

We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point
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Health.

The Senior Manager of Provider Performance leads the PPM Team in the development and execution of strategies aimed at optimizing the performance of our clinical provider network. The role plays a crucial role in achieving the highest standards of patient care and provider performance. Additionally, this role has oversight of Tufts Medicare Preferred Externally Managed relationships (Care Management and Utilization Management).

• Lead the management of clinical provider performance, including communication, performance evaluation, and issue resolution.
• Define, track, and report on key performance indicators (KPIs) to assess the effectiveness and quality of clinical providers.
• Collaborate with clinical providers to identify areas for improvement and develop performance improvement plans.
• Utilize data analysis and reporting to provide insights into provider performance and contribute to data-driven decision-making.
• Implement and oversee quality control measures to ensure the highest level of patient care and compliance with standards.
• Develop and maintain strong relationships with clinical providers, addressing inquiries, concerns, and promoting best practices.
• Work with the leadership team to create and execute strategies that enhance the overall performance of the clinical provider network.
• Manage a team of performance specialists, providing coaching and support to enhance their skills and performance.
• Other projects and duties as assigned.

• Certification and Licensure None Specified
• Education Required (minimum):
  Bachelor's degree in Healthcare Administration, Business, or a related field
• Preferred:
  Master's degree
• Required (minimum): 8-10 years of professional experience.
• Preferred: 8-10 years of experience in clinical provider performance management, quality improvement, or a related role with a successful track record in leadership
• Experience Required (minimum): 8-10 years of professional experience.
• Preferred: 8-10 years of experience in clinical provider performance management, quality improvement, or a related role with a successful track record in leadership.

• Strong analytical and problem-solving skills.
• Proficiency in healthcare data analysis, performance metrics, and quality assurance.
• Excellent communication and interpersonal skills.
• Proven ability to lead and manage a team effectively.
• Strategic thinking and the ability to drive process improvements.

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a…