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011230 CA-Provider Engagement & Performance

Position Summary:

The Provider Delegation Performance Manager is responsible for overseeing and improving the performance of CCA’s delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA’s One Care and SCO products. This role focuses on fostering strong clinical and programmatic collaboration, effectively communicating program performance to delegated providers, and supporting the implementation of CCA’s model of care and strategic objectives.

The Manager leads performance evaluation and improvement efforts, including reporting and data analysis, to ensure delegated entities meet contractual, regulatory, and quality standards that optimize member outcomes and operational efficiency.

This versatile position offers exposure across multiple organizational areas and involves close collaboration with program leadership, operations teams, and external provider partners. The ideal candidate will have excellent organizational and analytical skills, with the ability to engage and coordinate with diverse internal and external stakeholders to identify opportunities and drive both program-wide and provider-specific performance improvement.

Supervision Exercised:

• No, this position does not have direct reports.

Essential Duties & Responsibilities:

Performance Management:

• Assume full management responsibility for all performance measure components, including end-to-end data collection, evaluation, and timely dissemination of reports to both internal teams and delegated providers.

• Track and analyze site-level and program-wide KPIs to isolate gaps and identify key drivers of high and low performance.

• Generate monthly and quarterly performance and administrative reports, ensuring consistency, accuracy, and timely distribution to delegated providers. This includes reporting related to contracts, regulatory, NCQA and other requirements.

• Develop a deep understanding of all program measures and metrics to support delegated providers in interpreting performance data and meeting expectations.

• Collaborate with providers individually to create and monitor performance improvement plans, engaging internal subject matter experts as needed and ensuring accountability for baseline performance standards.

• Coordinate cross-departmental efforts to raise awareness of knowledge gaps and clarify expectations around performance metrics.

• Maintain ownership of all guidance materials related to performance measures, ensuring they are accurate and up to date.

• Manage the development of formal Performance Improvement Plans and prepare presentation materials such as mid-year and annual reviews and program-wide performance summaries.

• Support delegated provider staff in using data tools effectively and understanding data interpretation.

• Oversee administrative components related to performance management activities as needed.

• Lead the program’s contributions to performance measurement logic, reporting rules, exhibits, and reconciliation efforts in partnership with Business Intelligence, Finance, and Network teams.

• Understand CCA’s operational and contractual requirements for delegated providers and implement performance monitoring and workflow adherence plans accordingly.

• Partner with Business Intelligence/Analytics teams to develop and present clinical, operational, and financial reports, proactively identifying opportunities for improvement.

• Coordinate technical assistance initiatives, including convening multidisciplinary teams and leveraging specialized CCA resources to support provider performance improvement strategies.

• Support broader organizational efforts to drive performance on HEDIS and STAR measures.

• Schedule and facilitate regular meetings, virtual or in person, with CBOs focused on provider education, program operations, regulatory requirements, performance and care team collaboration

Delegation Governance Committee Management:

• Support cross-functional delegation governance Steering Committee

o Manage schedule and agenda for ongoing meetings

o Disseminate meeting notes

o Manage all action items

o Coordinate with staff managing Member communications to ensure alignment between provider and member communications

o Develop routine internal reports of provider communications activities to keep both leadership and provider facing staff apprised of messaging and timelines.

o Present reporting and trends to the committee

o Develop and manage annual provider communications schedule

Program Development and Operations Support:

• Assist with preparation and response activities related to formal CMS and state audits.

• Oversee special projects focused on program development, growth strategy, and new process design and implementation.

• Manage operational components of new program implementations, including project planning, stakeholder coordination, and deadline management.

• Collaborate across multiple internal teams and delegated providers to coordinate events, manage projects, and resolve daily operational issues.

• Support program leadership in developing and maintaining CCA Policies and procedures and trainings as they relate to delegation programs.

• Manages information, education and training to CCA staff, clinicians employed by CCA’s clinical groups, contracted delegated entities and LTSS providers on delegation model.

• Maintain reporting inventory of all reporting shared with Delegation Providers as well as received internally to support the programs

• Disseminate information to Delegation Partners

o Support Manager in developing guidelines, reference guides, workflows and SOPs, disseminating them to delegation entities and answering questions to ensure efficient day-to-day operations

o Draft email communications under supervision of Manager

o Support maintenance of materials and design of CCA Extranet/SharePoint as a key resource for information

o Ongoing communication with Delegated Provider staff and CCA internal departments through email and phone calls

Working Conditions:

• This is a remote or hybrid role with the expectation of working according to Commonwealth Care Alliance’s standard operating hours of 8:30am-5pm Monday-Friday.

Required Education (must have):

• Bachelor’s degree

Desired Education (nice to have):

• Master’s degree in public health, business administration, health management, social work, or a related field preferred.

Required Experience (must have):

• 5+ years

• Experience with Medicaid and Medicare products and programs

• Value-based program oversight and performance tracking

• Experience working within FQHCs, Health and Human services providers or equivalent

Desired Experience (nice to have):

• Experience with dual-eligible (DSNP) populations preferred.

• Understanding of behavioral health landscape in Massachusetts

Required Knowledge, Skills & Abilities (must have):

• Proven experience in program management and performance monitoring initiatives or relevant position

• Working knowledge of project/program management practices

• Ability to deal with a diverse and multi-disciplinary team

• Excellent problem-solving and organizing skills

• Strong written and oral communication skills and comfort presenting to large audiences

• Ability to create and use project management materials, such as project plan, timelines, etc. and work across stakeholders to drive towards a given deadline

• Skilled with data analytics and comfort with common analytics tools such as excel

• Ability to have a professional presence across internal and external stakeholders and across various levels and functions

• Outstanding verbal and written communication skills

• Professional presence and comfort in communicating with and presenting to senior level staff, including creation of external facing presentation materials

• Good knowledge of MS Office

• Must have ability to learn new systems and databases that CCA implements.

• Working knowledge of Medicare and Medicaid (MassHealth)

• Demonstrated skills in Excel and PowerPoint

• Polished, professional presentation skills in working with key provider partners and internal leaders.

• Exceptional written and verbal communication skills, with the ability to translate complex information for diverse provider and internal audiences.

• Ability to build and maintain positive relationships and collaborate effectively with internal and external stakeholders.

• Proactive in identifying issues and developing effective solutions.

• Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines.

• Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals.

• Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically.

• Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners

• Must be highly organized and self-directed with a proven ability to work with supervision on departmental and cross-functional projects of a diverse nature

• Requires excellent interpersonal skills in order to communicate and work with staff and external partners of all skill and experience levels

• Strong tactical performer

• Demonstrated ability to establish and manage performance and outcome metrics.

• Ability to establish and maintain positive and effective work relationships with internal staff, external vendors, and state and federal agencies

• Proven skills, knowledge base and judgment necessary for independent decision-making

• Excellent organizational, time-management and problem-solving skills

• Must be able to exercise a high level of diplomacy to recognize politically sensitive issues

• Ability to multi-task and switch gears quickly / effectively

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Familiarity with care management and utilization management systems and workflows.

• Experience managing delegated provider contracts and oversight programs.

• Project management skills with the demonstrated ability to handle multiple projects.

• Strong understanding of Medicare, Medicaid, duals program, and health plan operations, including regulatory and compliance requirements.

• Demonstrated knowledge of DMH system and waiver programs helpful.

• Demonstrated ability to describe and assess a simple business problem

• Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.