Provider Performance Program Manager

Title: Provider Performance Program Manager

Location: Fountain Valley, CA / Predominately Remote

Department: Value Based Care Admin

Status: Full-Time

Shift: Exempt

Pay Range*: $120,244.80 - $174,324.80/annually

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Provider Performance Program Manager is a key member of the MemorialCare Medical Foundation team responsible for identifying and consulting with providers to deploy appropriate interventions to drive success in value-based care. MCMF's at-risk managed care arrangements are aimed at reducing wasteful healthcare expenditures while improving patient outcomes and satisfaction. This role focuses on strategic problem solving, utilizing data-driven insights to identify cost drivers, manage utilization trends, and monitor the performance of MCMF's provider network.

The Provider Performance Program Manager will collaborate cross-functionally with internal MCMF departments, including but not limited to finance, network management, provider relations, and clinical leaders, to design and execute innovative cost-saving strategies, provide actionable insights to senior leadership, and uncover opportunities for MCMF to enhance quality of care while reducing professional costs, focusing on high-impact areas. They will be responsible for conducting comprehensive provider performance assessments, developing value-based care capabilities, and leading performance improvement initiatives that align with organizational strategic objectives.

Essential Functions and Responsibilities of the Job

1. Conduct comprehensive provider practice performance assessments to establish value-based capabilities of each assigned provider, identifying key opportunity areas and provider needs for optimal performance in risk-based contracts.

2. Utilize internal tools and reports to build meaningful and actionable value-based care (VBC) performance reports for providers, ensuring data accuracy and relevance to drive informed decision making.

3. Perform analytic interpretation and ongoing tracking of key performance metrics for each assigned provider and/or specialty, monitoring trends and identifying areas for improvement or intervention.

4. Establish collaborative performance meetings with existing contracted and employed provider groups and internal stakeholders to align performance goals, discuss challenges, and develop actionable improvement plans.

5. Create detailed reports and presentations for stakeholders, summarizing program impacts, cost trends, and strategic recommendations to address plan challenges and opportunities.

6. Lead development of performance improvement playbooks based on identified areas of opportunity using key performance indicators (KPIs), creating standardized approaches for consistent implementation across the provider network.

7. Manage assigned strategic initiatives and programs related to provider performance optimization to ensure achievement of objectives, timelines, key milestones, and overall success.

8. Collaborate with clinical leaders, finance teams, and network management to identify utilization patterns, cost drivers, and value-based optimization opportunities.

9. Develop and maintain relationships with provider partners, serving as point of contact for performance-related discussions.

10. Monitor regulatory and industry changes affecting value-based care arrangements and recommend adaptations to existing programs and strategies.

11. Provide education and training to providers on value-based care principles, performance metrics, and available resources to support their success.

12. Coordinate with quality improvement teams to ensure alignment between performance metrics and quality outcomes.

13. Analyze financial and clinical data to identify trends, patterns, and opportunities for cost reduction, including financial compensation design, while maintaining or improving quality of care.

14. Support contract negotiations by providing performance data and insights on provider capabilities and historical performance.

15. Develop and maintain documentation, templates, and standard operating procedures for provider performance management processes.

16. Be at work and be on time

17. Follow company policies, procedures and directives

18. Interact in a positive and constructive manner

19. Prioritize and multitask

20. Other duties as assigned

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out ourMemorialCare Benefitsfor more information about our Benefits and Rewards.