Provider Success Consultant – Pay for Quality

Role Overview

• Conduct detailed evaluations of provider practices to determine their current capabilities and identify key areas for growth and improvement.
• Engage in a continuous process that includes assessment, root cause analysis, strategy development, implementation, and outcomes tracking for each provider.
• Assist providers with executing action plans focused on population health management, patient satisfaction, and optimizing quality performance.
• Lead collaborative meetings with provider staff and internal stakeholders to ensure alignment and successful deployment of strategic initiatives.
• Create and deliver tailored learning opportunities to aid providers in implementing recommended interventions effectively.
• Educate providers on using proprietary tools, data, and technology to improve performance in critical metrics, driving effective and efficient care.
• Utilize data analytics to continuously monitor and track the key performance metrics for assigned providers, ensuring data-driven decision-making.
• Accurately document all action plans, interventions, and provider activities in Salesforce to maintain comprehensive records and reporting capabilities.
• Cultivate and maintain strong, long-term relationships with physicians, providers, and healthcare systems to support quality improvements within the health plan contract.
• Advise executives on developing segment-specific strategies in areas such as incentive programs, quality management, and other operational areas impacting provider success.
• Exercise independent judgment on complex issues, working under minimal supervision to evaluate variable factors and determine optimal courses of action.

Requirements

• Requires a BA/BS and minimum of 3 years health care experience; or any combination of education and experience, which would provide an equivalent background.
• Proven experience in consulting within the healthcare industry.
• Experience with Medicaid and Medicare plans strongly preferred.
• Strong understanding of quality-focused care principles and practices.
• Excellent analytical skills with the ability to interpret complex data and make strategic decisions.
• Experience with Salesforce or similar CRM platforms is preferred.

Benefits

• Health insurance
• 401(k) contribution
• Paid time off
• Professional development opportunities
• Wellness programs