Provider Consultant

Job Title

Healthcare Provider Consultant

Job Description

To act as a key liaison between healthcare providers and organizational initiatives, translating claims and Medicare data into actionable insights for shared savings, population health improvement, and value-based care outcomes.

Key Responsibilities

• Translate applicable claims and Medicare data into actionable strategies for shared savings.
• Serve as the primary point of communication with assigned practices, offering direct support and guidance.
• Manage and guide practices to achieve population health and value-based care initiatives.
• Conduct biweekly meetings with practices and provide detailed recaps.
• Analyze data to identify workflow improvement opportunities and deliver actionable recommendations.
• Ensure timely and accurate report turnaround and delivery.
• Monitor and update Salesforce (SF) and other tracking systems to reflect ongoing touchpoints and follow-ups.
• Provide continuous education and training for practice staff.
• Conduct quality reporting initiatives to ensure compliance with population health goals.
• Engage in market research to identify trends and their impact on healthcare delivery.
• Develop and implement innovative care solutions and resources.
• Foster strong relationships with stakeholders and ensure adherence to compliance measures.
• Escalate unresolved provider issues to Market Managers (MM) when necessary.

Key Performance Indicators (KPIs)

Measurable metrics derived from the key responsibilities.

• Report Turnaround Time (20%): Percentage of reports delivered on time.
• Meeting Recaps (15%): Completion and delivery rate of biweekly meeting summaries.
• Data Analytics (15%): Identification of trends and successful recommendations implemented at practices.
• Quality Compliance (20%): Incremental improvement of 2-5% year-over-year in quality metrics for the 30th percentile range (60-80%).
• Population Health Goals (15%): Percentage of gaps closed per practice (target: 75%).
• Education and Training (10%): Attendance and outcomes of training sessions as measured by engagement and comprehension (e.g., Kahoot scores).
• Market Research Deliverables (5%): Timeliness and accuracy of insights provided.

Evaluation and Weighting:

• Report Turnaround Time (20%): Meeting deadlines consistently for report delivery.
• Meeting Documentation (15%): Timely delivery and actionable insights from meeting recaps.
• Workflow Improvements (15%): Successful implementation of recommended changes.
• Quality Metrics (20%): Year-over-year improvement in compliance and closed gaps.
• Population Health Engagement (15%): Achieving target goals in population health initiatives.
• Training Outcomes (10%): Positive feedback and results from training sessions.
• Market Research Deliverables (5%): Accuracy and relevance of insights provided to stakeholders.

Required Skills and Competencies

Detail the skills and behaviors essential for success in this role.

Technical Skills

• Proficiency in Salesforce (SF), CareTracker (CT), and EMR systems.
• Strong analytical skills for interpreting healthcare data and trends.

Soft Skills

• Exceptional time management and organizational abilities.
• Assertive and persuasive communication.
• Goal-oriented and adaptable to dynamic environments.

Competencies

• Collaboration and relationship management.
• Innovative problem-solving and resourcefulness.
• Stakeholder management and the ability to influence outcomes.

Decision-Making Authority

Define the scope of decisions the role is empowered to make independently.

Decisions related to:

• Authorized to manage and resolve practice-level issues independently.
• Empowered to escalate unresolved issues to Market Manager of Operations.
• Responsible for setting and monitoring goals for assigned practices.

Reporting Structure

Specify who the role reports to and any direct or indirect reports.

• Reports To: Market Manager of Operations
• Direct Reports:
  • None

Required Experience and Education

List the qualifications necessary to perform the role effectively.

• Experience:
  • Minimum 3 years of experience in healthcare operations, consulting, or a related role
  • Familiarity with HIPAA regulations and quality standards in healthcare settings.
• Education:
  • Bachelor’s degree in Healthcare Administration, Business, or a related field.

Cultural Fit and Values Alignment

Define traits and values that align with the organization’s culture.

• [e.g., Collaborative, innovative, commitment to excellence]
• Adherence to company values: [e.g., integrity, diversity, sustainability]

Professional Growth Opportunities

Highlight development pathways and potential career progression.

• Access to [training programs, mentorship, certifications]
• Opportunities to advance to [specific roles/positions]

Review Frequency or Milestones

• Mid-year check-in and Annual Review
• 30/60/90-day expectations for new hires