Provider Performance Specialist

Job Summary

Supporting performance improvement initiatives remotely, the full-time Provider Performance Specialist will serve as a primary operational partner to assigned providers and clinics, focusing on provider education delivery, escalation management, and execution of quality, access, and documentation initiatives across Medicaid and Medicare Advantage lines of business.

Key responsibilities

• Manage performance improvement initiatives by collaborating with providers and clinics to enhance quality and access
• Deliver structured education and facilitate discussions on performance metrics to support workflow adoption within practices
• Analyze operational performance dashboards and identify performance gaps to track improvement actions and outcomes

Required qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Health Informatics, or a related field, or equivalent experience
• Three years of experience in a healthcare payer, provider organization, managed care environment, or population health program
• Experience working directly with providers, clinics, or care teams
• Familiarity with HEDIS, Stars, or Risk Adjustment programs or initiatives
• Knowledge of Medicaid managed care operations and Medicare Advantage