Provider Performance Specialist in Corvallis, Oregon at Samaritan Health Services
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Job Description
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This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
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JOB SUMMARY/PURPOSE
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Serves as a primary operational partner to assigned providers and clinics, supporting performance improvement initiatives aligned with the Plan Performance operating model. Focuses on provider education delivery, escalation management, and execution of quality, access, and documentation initiatives across Medicaid and Medicare Advantage lines of business.
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DEPARTMENT DESCRIPTION
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Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
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EXPERIENCE/EDUCATION/QUALIFICATIONS
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Bachelor’s degree in Healthcare Administration, Public Health, Health Informatics, or a related field, or equivalent related experience required.
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Three (3) years of experience in a healthcare payer, provider organization, managed care environment, or population health program required.
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Experience in the following preferred:
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Working directly with providers, clinics, or care teams.
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HEDIS, Stars, or Risk Adjustment programs or initiatives.
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Medicaid or Medicare Advantage environments.
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Quality improvement, population health, provider relations, care coordination or project management.
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Working in value-based care programs.
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Clinical operations, medical office workflows, or practice administration.
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KNOWLEDGE/SKILLS/ABILITIES
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Working understanding of provider network workflows, preventative care and chronic condition management concepts, healthcare quality programs, and basic risk adjustment concepts.
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Knowledge of Medicaid managed care operations and Medicare Advantage.
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Strong communication and facilitation skills, strong verbal and written communication skills, ability to translate complex concepts into practical actions, excellent organization and follow through, and ability to operate independently within defined strategy.
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Ability to assimilate and interpret operational performance dashboards, explain performance metrics to non-technical audiences, identify performance gaps using structured reports, and track improvement actions and outcomes.
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Ability to work with Excel reports, provider scorecards, gap lists, and performance tracking tools. Ability to develop KPIs and provider performance scorecards.
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Ability to build professional relationships with clinic staff and providers, deliver structured provider education, facilitate performance improvement discussions, and support workflow adoption within practices.
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Basic functional understanding of preventive care gap closure, annual wellness/annual visit workflows, documentation importance for patient complexity, and quality measure improvement activities.
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PHYSICAL DEMANDS
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Rarely
(1 - 10% of the time)Occasionally
(11 - 33% of the time)Frequently
(34 - 66% of the time)Continually
(67 – 100% of the time)CLIMB - STAIRS
LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT (Knee to chest: 24"-54") 0 – 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK – LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0 - 20 pounds force)
PULL (0 - 20 pounds force)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
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