Practice Performance Advisor

<p class="MsoNoSpacing"><strong>Role Overview:</strong> The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes.<span> </span>This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.</p><p class="MsoNoSpacing"><strong>Work Arrangements:</strong></p><ul><li>Remote – The associate can be located anywhere in Michigan (MI).<span></span></li><li>50% travel is required to the provider’s location and attend office meetings at our Southfield, MI location.</li></ul><p class="MsoNoSpacing"><strong>Responsibilities:</strong></p><ul><li>Produce all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for the Joint Operating Committee (JOC).</li><li>Present information to the provider, colleagues, and the executive team in a clear, concise manager</li><li>Analyze claims data, utilization trends, and patient outcomes to support performance optimization</li><li>Support provider engagement related to Healthcare Effectiveness Data and Information Set (HEDIS), Total Cost of Care (TCOC), and other performance-based programs</li><li>Partner with Quality, Provider Network, and Account Executive teams to align strategies and improve provider performance</li><li>Participate in provider meetings to review gaps in care and develop action plans in collaboration with Provider Network Management (PNM) and Chief Medical Officer (CMO) teams</li><li>Lead and support performance improvement initiatives and projects aligned with corporate strategy and best practices</li><li>Identify opportunities using data and collaborate with internal teams to develop and implement targeted intervention strategies</li><li>Track, monitor, and report on provider action plans and outcomes to measure the effectiveness of initiatives</li><li>Support network and quality strategy execution across markets</li><li>Maintain strong cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality teams to achieve performance goals</li><li>May assist with member outreach efforts and coordination of care-related activities</li></ul><p class="MsoNoSpacing"><strong>Education & Experience:</strong></p><ul><li>Bachelor’s degree in healthcare administration or related field required</li><li>3 years of Account Executive experience or provider engagement experience, demonstrating knowledge of TCOC and Medical Loss Ratio (MLR) analysis, is required.</li><li>Experience in a variety of provider reimbursement methodologies, including value-based or risk-based contracting</li><li>Understand quality and provider performance reporting, including HEDIS and other quality measures.</li></ul><p><strong>Licensure:</strong></p><ul><li>Valid driver's license, transportation, and insurance required:</li></ul><p class="MsoNoSpacing"><strong>Skills & Abilities:</strong></p><ul><li>Strong understanding of healthcare regulations, reimbursement models, and quality metrics, specifically in HEDIS and STARS</li><li>Ability to analyze and interpret complex healthcare data and translate insights into actionable strategies</li><li>Knowledge of provider operations, including claims coding, payment integrity, credentialing, appeals, and disputes</li><li>Experience working with value-based care programs and performance measures</li><li>Excellent communication and collaboration skills with the ability to engage providers and cross-functional teams</li><li>Strong analytical, problem-solving, and reporting capabilities</li><li>Ability to manage multiple priorities and drive performance improvement initiatives</li></ul>